Compositions and methods for selecting a treatment for b-cell neoplasias

ABSTRACT

The present invention features compositions and methods for identifying a subject having a B cell neoplasia or related condition responsive to treatment with lenalidomide and lenalidoinide-related compounds.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/902,066, filed Nov. 8, 2013, and U.S. Provisional Application Ser. No. 61/915,439, filed Dec. 12, 2013, the contents of which are incorporated herein by reference.

STATEMENT OF RIGHTS TO INVENTIONS MADE UNDER FEDERALLY SPONSORED RESEARCH

This work was supported by the following grants from the National Institutes of Health, Grant Nos: R01HL082945 and P01 CA108631. The government has certain rights in the invention.

BACKGROUND OF THE INVENTION

B lymphocytes are an important cellular component of the adaptive immune system. When normal B-cell development goes awry, B-cell neoplasia can result. B cell neoplasms include multiple myeloma, mantle cell lymphoma and chronic lymphocytic leukemia. Multiple myeloma is a malignant plasma cell disorder and is the second most common hematologic malignancy in the United States, with about 20 000 patients diagnosed annually. Most patients diagnosed with multiple myeloma survive for only 2-3 years. In contrast, patients with mantle cell lymphoma may survive between 5 and 7 years. However, for most multiple myeloma patients, the disease eventually progresses or returns, and over time treatment resistance often develops. Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia. In the U.S. alone, about 15,000 patients will be diagnosed with CLL in 2013, and almost 5,000 deaths from CLL will occur. MDS is diagnosed in more than 15,000 new patients per year, and deletions of chromosome 5q are the most common cytogenetic abnormality. As with virtually all cancers, prognosis is improved by the early identification of disease and initiation of an appropriate therapeutic regimen. Similarly, it is important to detect treatment resistance to a particular agent early, so that alternate forms of therapy can be provided.

SUMMARY OF THE INVENTION

As described below, the present invention features compositions and methods for identifying a subject having a B cell neoplasia or myelodysplastic syndrome/acute myeloid leukemia responsive to treatment with lenalidomide and lenalidomide-related compounds.

In one aspect, the invention provides a method of characterizing the lenalidomide- or lenalidomide analog sensitivity of a subject having a neoplasia characterized by increased IKZF1 or IKZF3 polypeptide expression, the method involving contacting a cell derived from the neoplasia with lenalidomide or a lenalidomide analog; and detecting the level of an IKZF1 or IKZF3 polypeptide in the cell relative to the level in an untreated control cell, where detection of a decrease in IKZF1 or IKZF3 polypeptide level identifies the neoplasia as sensitive to lenalidomide or a lenalidomide analog and the absence of a decrease in IKZF1 or IKZF3 polypeptide level identifies the neoplasia as lenalidomide- or lenalidomide analog resistant.

In another aspect, the invention provides a method of characterizing the lenalidomide, thalidomide, or pomalidomide sensitivity of a subject having a B cell neoplasia, the method involving detecting increased IKZF1 or IKZF3 polypeptide level in a biological sample of the subject relative to the level present in a reference, where an increased level of IKZF1 or IKZF3 polypeptide is indicative of lenalidomide, thalidomide, or pomalidomide sensitivity.

In yet another aspect, the invention provides a method of characterizing the lenalidomide or lenalidomide analog sensitivity of a subject having a neoplasia or related condition, the method involving contacting a biological sample of the subject with lenalidomide or a lenalidomide analog; and detecting increased or decreased IKZF1 or IKZF3 polypeptide ubiquitination relative to the level present in a reference. In one embodiment, the method is carried out in the presence of a proteasome inhibitor.

In still another aspect, the invention provides a method of characterizing the lenalidomide- or lenalidomide analog sensitivity of a subject having a neoplasia or related condition, the method involving detecting binding of CRBN to an IKZF1 or IKZF3 polypeptide in a biological sample of the subject relative to the level present in a reference, where detection of binding is indicative of lenalidomide- or lenalidomide analog sensitivity and a reduction in binding is indicative of lenalidomide- or lenalidomide analog resistance.

In another aspect, the invention provides a method of characterizing lenalidomide sensitivity in a subject having a B cell neoplasia or related condition, the method involving detecting the sequence of an IKZF1 or IKZF3 polypeptide or polynucleotide in a biological sample obtained from the subject relative to a IKZF1 or IKZF3 reference sequence, where detection of a mutation in the IKZF1 or IKZF3 polypeptide or polynucleotide sequence is indicative of lenalidomide resistance and failure to detect a mutation is indicative of lenalidomide sensitivity.

In another aspect, the invention provides a method of monitoring lenalidomide sensitivity in a subject having a B cell neoplasia or related condition, the method involving detecting the sequence of an IKZF1 or IKZF3 polypeptide or polynucleotide in a biological sample obtained from the subject relative to a IKZF1 or IKZF3 reference sequence, where detection of a mutation in the IKZF1 or IKZF3 polypeptide or polynucleotide sequence is indicative of lenalidomide resistance and failure to detect a mutation is indicative of lenalidomide sensitivity.

In still another aspect, the invention provides a method of reducing the proliferation of a cell characterized by increased IKZF1 or IKZF3 polypeptide expression, the method involving contacting the cell with an inhibitory nucleic acid molecule that reduces the expression of activity of an IKZF1 or IKZF3 polypeptide. In one embodiment, the inhibitory nucleic acid molecule is an antisense nucleic acid molecule, shRNA, siRNA molecule, or Crispr. In another embodiment, the inhibitory nucleic acid molecule is expressed from a viral vector.

In yet another aspect, the invention provides a method of reducing the proliferation of a cell, the method comprising contacting the cell with an inhibitory nucleic acid molecule that decreases the expression of casein kinase 1 and lenalidomide or a lenalidomide analog. In one embodiment, the inhibitory nucleic acid molecule is an antisense nucleic acid molecule, shRNA, siRNA molecule, or Crispr. In another embodiment, the inhibitory nucleic acid molecule is expressed from a viral vector.

In another aspect, the invention provides a recombinant murine cell containing a polynucleotide encoding a human CRBN polypeptide. In one embodiment, the cell comprises an expression vector encoding the CRBN polypeptide. In another embodiment, the expression vector is a viral vector.

In still another aspect, the invention provides a recombinant murine cell containing a polynucleotide encoding a mutant CRBN polypeptide. In one embodiment, the mutant CRBN polypeptide comprises at least one substitution selected from the group consisting of S369C, V380E, and I391V. In another embodiment, the cell comprises an expression vector encoding the CRBN polypeptide. In still another embodiment, the expression vector is a viral vector.

In another aspect, the invention provides a transgenic mouse or knock-in mouse containing a polynucleotide encoding a human CRBN polypeptide. In one embodiment, the mouse is pregnant.

In another aspect, the invention provides a transgenic mouse or knock-in mouse containing a polynucleotide encoding a mutant CRBN polypeptide. In one embodiment, the mouse is pregnant.

In another aspect, the invention provides a method for assessing teratogenicity of lenalidomide or an analog thereof, the method involving contacting the pregnant mouse of claim 27 with lenalidomide or an analog thereof, and assessing teratogenicity in the murine pups produced by the pregnant mouse. In one embodiment, teratogenicity is assessed prenatally or post natally.

In another aspect, the invention provides a method of assessing lenalidomide sensitivity in the transgenic mouse of claim 26, the method involving contacting a mouse of claim 26 with lenalidomide or an analog thereof, and assessing lenalidomide sensitivity. In one embodiment, lenalidomide sensitivity is assessed by assaying IKZF1 or IKZF3 levels or ubiquitination, by assessing CRBN binding, by assaying for an alteration in the immune system, or by assaying neoplastic cell proliferation. In another embodiment, the immune system is assayed by analyzing B cell and T cell function

In another aspect, the invention provides a derivative of lenalidomide of formula 1:

In another aspect, the invention provides a method of screening for agents that bind lenalidomide, the method involving contacting the derivative of the above aspect with the agent and detecting binding to the derivative.

In yet another aspect, the invention provides a method of screening for agents that increase lenalidomide binding to CRBN, the method involving contacting the derivative of a previous aspect and CRBN with an agent, and detecting increased binding of CRBN to the derivative. In one embodiment, binding to CRBN is assayed by detecting the affinity of binding, by detecting ubiquination of IKZF1 or IKZF3, by detecting degradation of IKZF1 or IKZF3.

In another aspect, the invention provides a method of screening for agents that activate ubiquitin ligase, the method involving contacting a ubiquitin ligase with the agent in the presence of IKZF1 or IKZF3, and detecting ubiquitin ligase activation. In one embodiment, the screen is carried out in a cell. In another embodiment, global protein ubiquitination and alterations in global protein levels are assayed. In yet another embodiment, the method involves detecting increased IKZF1 or IKZF3 ubiquitination, increased IKZF1 or IKZF3 degradation, or increased IKZF1 or IKZF3 binding to CRBN. In another embodiment, the ubiquitin ligase is present in a normal or neoplastic cell. In another embodiment, the method involves detecting a decrease in neoplastic cell proliferation.

In another aspect, the invention provides a method of identifying an agent that treats a myelodysplastic syndrome, the method involving contacting the cell with the agent and detecting a decrease in casein kinase 1A1 polypeptide level in the cell relative to the level present in a reference, thereby identifying the agent as treating myelodysplastic syndrome. In one embodiment, the a cell containing a 5q deletion.

In another aspect, the invention provides a method of characterizing the lenalidomide or lenalidomide analog sensitivity of a subject having myelodysplastic syndrome, the method involving contacting a biological sample of the subject with lenalidomide or a lenalidomide analog; and detecting altered casein kinase 1A1 polypeptide ubiquitination relative to the level present in a reference. In one embodiment, the method is carried out in the presence of a proteasome inhibitor.

In various embodiments of the above aspects or any other aspect of the invention delineated herein, the lenalidomide analog is thalidomide or pomalidomide. In other embodiments of the above aspects or any other aspect of the invention delineated herein, the neoplasia is a B or T cell neoplasia. In other embodiments, the B or T cell neoplasia is mantle cell lymphoma, chronic lymphocytic leukemia, multiple myeloma, or B cell lymphoma. In other embodiments, the decrease in IKZF1 or IKZF3 polypeptide level is by at least about 20% or is undetectable by Western blot. In other embodiments, IKZF1 or IKZF3 polypeptide level is detected by immunoassay, radioimmunoassay, immunohistochemistry, FACS analysis, or quantitative fluorescent microscopy. In other embodiments, the B cell neoplasia is mantle cell lymphoma, chronic lymphocytic leukemia, multiple myeloma cell, or B cell lymphoma. In another embodiment, the mutation is in amino acids 160-180 of IKZF3. In other embodiments, the mutation reduces IKZF3 binding to CRBN or reduces IKZF3 degradation in response to lenalidomide. In other embodiments, the mutation is at amino acid position 147, 150, 161, or 162. In other embodiments, the mutation is Q147H, Q1501-1, L161R, or L162R. In other embodiments, a mutation in an IKZF1 or IKZF3 polypeptide is detected by assaying antibody binding to amino acids 160-180. In another embodiment, a mutation is an IKZF1 or IKZF3 polynucleotide is detected by sequencing or hybridization.

Other features and advantages of the invention will be apparent from the detailed description, and from the claims.

DEFINITIONS

Unless defined otherwise, all technical and scientific terms used herein have the meaning commonly understood by a person skilled in the art to which this invention belongs. The following references provide one of skill with a general definition of many of the terms used in this invention: Singleton et al., Dictionary of Microbiology and Molecular Biology (2nd ed. 1994); The Cambridge Dictionary of Science and Technology (Walker ed., 1988); The Glossary of Genetics, 5th Ed., R. Rieger et al. (eds.), Springer Verlag (1991); and Hale & Marham, The Harper Collins Dictionary of Biology (1991). As used herein, the following terms have the meanings ascribed to them below, unless specified otherwise.

By “IKZF1 polypeptide” is meant a polypeptide having at least about 85% amino acid sequence identity to a sequence provided at NCBI Accession No. AAH18349, NP_006051, NP_001207694, or a fragment thereof and having DNA binding or transcriptional regulatory activity.

For IKZF1 Isoform 1, the degron is from 130-270. For IKZF1 Isoform 2, the degron is from amino acid 136-180/236-249. Both isoforms are responsive to lenalidomide. Exemplary amino acid sequences for the two isoforms are provided below:

IKZF1 isoform 2 NCBI Reference No. NP_001207694 1 mdadegqdms qvsgkesppv sdtpdegdep mpipedlstt sggqqssksd rvvasnvkve 61 tqsdeengra cemngeecae dlrmldasge kmngshrdqg ssalsgvggi rlpngklkcd 121 icgiicigpn vlmvhkrsht gerpfqcnqc gasftqkgnl lrhiklhsge kpfkchlcny 181 acrrrdaltg hlrthsvike etnhsemaed lckigsersl vldrlasnva krkssmpqkf 241 lgdkglsdtp ydssasyeke nemmkshvmd qainnainyl gaeslrplvq tppggsevvp 301 vispmyqlhk plaegtprsn hsaqdsaven llllskaklv psereaspsn scqdstdtes 361 nneeqrsgli yltnhiapha rnglslkeeh raydllraas ensqdalrvv stsgeqmkvy 421 kcehcrvlfl dhvmytihmg chgfrdptec nmcgyhsqdr yefsshitrg ehrfhms IKZF1 isoform 1 NCBI Reference No. NP_006051 1 mdadegqdms qvsgkesppv sdtpdegdep mpipedlstt sggqqssksd rvvasnvkve 61 tqsdeengra cemngeecae dlrmldasge kmngshrdqg ssalsgvggi rlpngklkcd 121 icgiicigpn vlmvhkrsht gerpfqenqc gasftqkgnl lrhiklhsge kpfkchlcny 181 acrrrdaltg hlrthsvgkp hkcgycgrsy kqrssleehk erchnylesm glpgtlypvi 241 keetnhsema edlckigser slvldrlasn vakrkssmpq kflgdkglsd tpydssasye 301 kenemmkshv mdqainnain ylgaeslrpl vqtppggsev vpvispmyql hkplaegtpr 361 snhsaqdsav enllllskak lvpsereasp snscqdstdt esnneeqrsg liyltnhiap 421 harnglslke ehraydllra asensqdalr vvstsgeqmk vykcehcrvl fldhvmytih 481 mgchgfrdpf ecnmcgyhsq dryefsshit rgehrfhms

By “IKZF1 polynucleotide” is meant a polynucleotide encoding an IKZF1 polypeptide. An exemplary IKZF1 polynucleotide is provided at NM_006060.4 and reproduced below:

1 ggcagcagag gaaccttttg gaggaggaag aggacacaga ggccctgtag ccaggcacca 61 agatccctcc caggtggctg ggtctgaggg gaactccgag cagccctagg tcctcaaagt 121 ctggatttgt gtggaaaagg cagctctcac ttggccttgg cgaggcctcg gttggttgat 181 aacctgagga ccatggatgc tgatgagggt caagacatgt cccaagtttc agggaaggaa 241 agcccccctg taagcgatac tccagatgag ggcgatgagc ccatgccgat ccccgaggac 301 ctctccacca cctcgggagg acagcaaagc tccaagagtg acagagtcgt ggccagtaat 361 gttaaagtag agactcagag tgatgaagag aatgggcgtg cctgtgaaat gaatggggaa 421 gaatgtgcgg aggatttacg aatgcttgat gcctcgggag agaaaatgaa tggctcccac 481 agggaccaag gcagctcggc tttgtcggga gttggaggca ttcgacctcc taacggaaaa 541 ctaaagtgtg atatctgtgg gatcatttgc atcgggccca atgtgctcat ggttcacaaa 601 agaagccaca ctggagaacg gcccttccag tgcaatcagt gcggggcctc attcacccag 661 aagggcaacc tgctccggca catcaagctg cattccgggg agaagccctt caaatgccac 721 ctctgcaact acgcctgccg ccggagggac gccctcactg gccacctgag gacgcactcc 781 gtcattaaag aagaaactaa tcacagtgaa atggcagaag acctgtgcaa gataggatca 841 gagagatctc tcgtgctgga cagactagca agtaacgtcg ccaaacgtaa gagctctatg 901 cctcagaaat ttcttgggga caagggcctg tccgacacgc cctacgacag cagcgccagc 961 tacgagaagg agaacgaaat gatgaagtcc cacgtgatgg accaagccat caacaacgcc 1021 atcaactacc tgggggccga gtccctgcgc ccgctggtgc agacgccccc gggcggttcc 1081 gaggtggtcc cggtcatcag cccgatgtac cagctgcaca agccgctcgc ggagggcacc 1141 ccgcgctcca accactcggc ccaggacagc gccgtggaga acctgctgct gctctccaag 1201 gccaagttgg tgccctcgga gcgcgaggcg tccccgagca acagctgcca agactccacg 1261 gacaccgaga gcaacaacga ggagcagcgc agcggtctca tctacctgac caaccacatc 1321 gccccgcacg cgcgcaacgg gctgtcgctc aaggaggagc accgcgccta cgacctgctg 1381 cgcgccgcct ccgagaactc gcaggacgcg ctccgcgtgg tcagcaccag cggggagcag 1441 atgaaggtgt acaagtgcga acactgccgg gtgctcttcc tggatcacgt catgtacacc 1501 atccacatgg gctgccacgg cttccgtgat ccttttgagt gcaacatgtg cggctaccac 1561 agccaggacc ggtacgagtt ctcgtcgcac ataacgcgag gggagcaccg cttccacatg 1621 agctaaagcc ctcccgcgcc cccaccccag accccgagcc accccaggaa aagcacaagg 1681 actgccgcct tctcgctccc gccagcagca tagactggac tggaccagac aatgttgtgt 1741 ttggatttgt aactgttttt tgttttttgt ttgagttggt tgattggggt ttgagttggt 1801 tttgaaaaga tttttatttt tagaggcagg gctgcattgg gagcatccag aactgctacc 1861 ttcctagatg tttccccaga ccgctggctg agattccctc acctgtcgct tcctagaatc 1921 cccttctcca aacgattagt ctaaattttc agagagaaat agataaaaca cgccacagcc 1981 tgggaaggag cgtgctctac cctgtgctaa gcacggggtt cgcgcaccag gtgtcttttt 2041 ccagtcccca gaagcagaga gcacagcccc tgctgtgtgg gtctgcaggt gagcagacag 2101 gacaggtgtg ccgccaccca agtgccaaga cacagcaggg ccaacaacct gtgcccaggc 2161 cagcttcgag ctacatgcat ctagggcgga gaggctgcac ttgtgagaga aaatactatt 2221 tcaagtcata ttctgcgtag gaaaatgaat tggttgggga aagtcgtgtc tgtcagactg 2281 ccctgggtgg agggagacgc cgggctagag cctttgggat cgtcctggat tcactggctt 2341 tgcggaggct gctcagatgg cctgagcctc ccgaggcttg ctgccccgta ggaggagact 2401 gtcttcccgt gggcatatct ggggagccct gttccccgct ttttcactcc cataccttta 2461 atggccccca aaatctgtca ctacaattta aacaccagtc ccgaaatttg gatcttcttt 2521 ctttttgaat ctctcaaacg gcaacattcc tcagaaacca aagctttatt tcaaatctct 2581 tccttccctg gctggttcca tctagtacca gaggcctctt ttcctgaaga aatccaatcc 2641 tagccctcat tttaattatg tacatctgtt tgtagccaca agcctgaatt tctcagtgtt 2701 ggtaagtttc tttacctacc ctcactatat attattctcg ttttaaaacc cataaaggag 2761 tgatttagaa cagtcattaa ttttcaactc aatgaaatat gtgaagccca gcatctctgt 2821 tgctaacaca cagagctcac ctgtttgaaa ccaagctttc aaacatgttg aagctcttta 2881 ctgtaaaggc aagccagcat gtgtgtccac acatacatag gatggctggc tctgcacctg 2941 taggatattg gaatgcacag ggcaattgag ggactgagcc agaccttcgg agagtaatgc 3001 caccagatcc cctaggaaag aggaggcaaa tggcactgca ggtgagaacc ccgcccatcc 3061 gtgctatgac atggaggcac tgaagcccga ggaaggtgtg tggagattct aatcccaaca 3121 agcaagggtc tccttcaaga ttaatgctat caatcattaa ggtcattact ctcaaccacc 3181 taggcaatga agaatatacc atttcaaata tttacagtac ttgtcttcac caacactgtc 3241 ccaaggtgaa atgaagcaac agagaggaaa ttgtacataa gtacctcagc atttaatcca 3301 aacaggggtt cttagtctca gcactatgac attttgggct gactacttat ttgttaggca 3361 ggagctctcc tgtgcattgt aggataatta gcagtatccc tggtggctac ccaatagacg 3421 ccagtagcac cccgaattga caacccaaac tctccagaca tcaccaactg tcccctgcga 3481 ggagaaatca ctcctggggg agaaccactg acccaaatga attctaaacc aatcaaatgt 3541 ctgggaagcc ctccaagaaa aaaaaaaaaa aa

By “IKZF3 polypeptide” is meant a protein having at least about 85% amino acid sequence identity to NCBI Accession No. NP_036613.2 (UnitPro Identifier No. Q9UKT9-1) or a fragment thereof and having DNA binding or transcriptional regulatory activity. An exemplary amino acid sequence of IKZF3 is provided below.

        10         20         30         40         50         60 MEDIQTNAEL KSTQEQSVPA ESAAVLNDYS LTKSHEMENV DSGEGPANED EDIGDDSMKV         70         80         90        100        110        120 KDEYSERDEN VLKSEPMGNA EEPEIPYSYS REYNEYENIK LERHVVSFDS SRPTSGKMNC        130        140        150        160        170        180 DVCGLSCISF NVLMVHKRSH TGERPFQCNQ CGASFTQKGN LLRHIKLHTG EKPFKCHLCN        190        200        210        220        230        240 YACQRRDALT GHLRTHSVEK PYKCEFCGRS YKQRSSLEEH KERCRTFLQS TDPGDTASAE        250        260        270        280        290        300 ARHIKAEMGS ERALVLDRLA SNVAKRKSSM PQKFIGEKRH CFDVNYNSSY MYEKESELIQ        310        320        330        340        350        360 TRMMDQAINN AISYLGAEAL RPLVQTPPAP TSEMVPVISS MYPIALTRAE MSNGAPQELE        370        380        390        400        410        420 KKSIHLPEKS VPSERGLSPN NSGHDSTDTD SNHEERQNHI YQQNHMVLSR ARNGMPLLKE        430        440        450        460        470        480 VPRSYELLKP PPICPRDSVK VINKEGEVMD VYRCDHCRVL FLDYVMFTIH MGCHGFRDPF        490        500 ECNMCGYRSH DRYEFSSHIA RGEHRALLK

By “IKZF3 polynucleotide is meant a nucleic acid sequence encoding an IKZF3 polypeptide. An exemplary polynucleotide sequence is provided at NCBI Accession No. NM_012481, which is reproduced below:

1 gcaggagcac gtggagaggc cgagtagcca cagcggcagc tccagcccgg cccggcagcg 61 acatggaaga tatacaaaca aatgcggaac tgaaaagcac tcaggagcag tctgtgcccg 121 cagaaagtgc agcggttttg aatgactaca gtttaaccaa atctcatgaa atggaaaatg 181 tggacagtgg agaaggccca gccaatgaag atgaagacat aggagatgat tcaatgaaag 241 tgaaagatga atacagtgaa agagatgaga atgttttaaa gtcagaaccc atgggaaatg 301 cagaagagcc tgaaatccct tacagctatt caagagaata taatgaatat gaaaacatta 361 agttggagag acatgttgtc tcattcgata gtagcaggcc aaccagtgga aagatgaact 421 gcgatgtgtg tggattatcc tgcatcagct tcaatgtctt aatggttcat aagcgaagcc 481 atactggtga acgcccattc cagtgtaatc agtgtggggc atcttttact cagaaaggta 541 acctcctccg ccacattaaa ctgcacacag gggaaaaacc ttttaagtgt cacctctgca 601 actatgcatg ccaaagaaga gatgcgctca cggggcatct taggacacat tctgtggaga 661 aaccctacaa atgtgagttt tgtggaagga gttacaagca gagaagttcc cttgaggagc 721 acaaggagcg ctgccgtaca tttcttcaga gcactgaccc aggggacact gcaagtgcgg 781 aggcaagaca catcaaagca gagatgggaa gtgaaagagc tctcgtactg gacagattag 841 caagcaatgt ggcaaaacga aaaagctcaa tgcctcagaa attcattggt gagaagcgcc 901 actgctttga tgtcaactat aattcaagtt acatgtatga gaaagagagt gagctcatac 961 agacccgcat gatggaccaa gccatcaata acgccatcag ctatcttggc gccgaagccc 1021 tgcgcccctt ggtccagaca ccgcctgctc ccacctcgga gatggttcca gttatcagca 1081 gcatgtatcc catagccctc acccgggctg agatgtcaaa cggtgcccct caagagctgg 1141 aaaagaaaag catccacctt ccagagaaga gcgtgccttc tgagagaggc ctctctccca 1201 acaatagtgg ccacgactcc acggacactg acagcaacca tgaagaacgc cagaatcaca 1261 tctatcagca aaatcacatg gtcctgtctc gggcccgcaa tgggatgcca cttctgaagg 1321 aggttccccg ctcttacgaa ctcctcaagc ccccgcccat ctgcccaaga gactccgtca 1381 aagtgatcaa caaggaaggg gaggtgatgg atgtgtatcg gtgtgaccac tgccgcgtcc 1441 tcttcctgga ctatgtgatg ttcacgattc acatgggctg ccacggcttc cgtgaccctt 1501 tcgagtgtaa catgtgtgga tatcgaagcc atgatcggta tgagttctcg tctcacatag 1551 ccagaggaga acacagagcc ctgctgaagt gaatatctgg tctcagggat tgctcctatg 1621 tattcagcat cgtttctaaa aaccaatgac ctcgcctaac agattgctct caaaacatac 1681 tcagttccaa acttcttttc ataccatttt tagctgtgtt cacaggggta gccagggaaa 1741 cactgtcttc cttcagaaat tattcgcagg tctagcatat tattactttt gtgaaacctt 1801 tgttttccca tcagggactt gaattttatg gaatttaaaa gccaaaaagg tatttggtca 1861 ttatcttcta cagcagtgga atgagtggtc ccggagatgt gctatatgaa acattctttc 1921 tgagatatat caaccacacg tggaaaagcc tttcagtcat acatgcaaat ccacaaagag 1981 gaagagctga ccagctgacc ttgctgggaa gcctcaccct tctgcccttc acaggctgaa 2041 gggttaagat ctaatctccc taatctaaat gacagtctaa gagtaagtaa aagaacagcc 2101 ataaaataag tatctgttac gagtaactga agaccccatt ctccaagcat cagatccatt 2161 tcctatcaca acatttttaa aaaatgtcat ctgatggcac ttctgcttct gtcctttacc 2221 ttcccatctc cagtgaaaag ctgagctgct ttgggctaaa ccagttgtct atagaagaaa 2281 atctatgcca gaagaactca tggttttaaa tatagaccat catcgaaact ccagaaattt 2341 atccactgtg gatgatgaca tcgctttcct ttggtcaagg ttggcagagc aagggtataa 2401 agggggaaat tgtttggcag caccaacaga aaacaaacaa acaaaaaaca gctacctaaa 2461 acttcttgaa agagttcatg gagaattggt gatacagacc caaagcaaat ttgccaatga 2521 tattttccac aaaaaaagtc caaaaagtat ggctcagcct ccccctcccc acaggagagg 2581 aattggagat agatggcatg tgtgtttaga tcggagttga gctccggaat ggggtgagga 2641 gggacacctc tattgagagg ttctccttga tcaggcaggc ttcggccctt tttttcccat 2701 ttaaatggaa ctgctgtatt ccatgaaaat tcctgaaagt ctgatcacgg ttctgcagat 2761 gtataagtca tccttgtcac tcataatatg tacatactat caggaggagt gctgttatca 2821 tggtaaaatt agcactggaa taggaggtca caaaatgctg gctaattagc tatgtgactt 2881 tgagaaatcg tttaactttt tttttttttt tttttttgag acaggatctc actctgttgc 2941 ccaggctgga gtgcagtggt gcaatcatgg ctcagtgcag cctcgacctc cccaggctca 3001 ggtgatcctc ccacctcagc ctcttgagta ctgggacaac aagtgcacac caccatgtct 3061 ggctacattt tgttcttttt gtagagatag gggtctcact atgttgccca tgctggtctt 3121 gaactcctgg gctcaagcaa tcagcccgcc tcagccccct aaagtgctgg gattacaggt 3181 gtgagccacc acacccagcc ttatttaact cttaaaactc agtttccggc caggctcggt 3241 ggctcacacc tgtaatccca acactttggg aagccgaggc aggcgcatca tttgaggtca 3301 ggagttcgag accagcctga cccacatggt gaaaccctgt ctctactaaa aatacaaaaa 3361 ttagctgggc agtagtggca catgcctgta atcccagcta ctccggaggc tgaggcagaa 3421 aaatcgctta agcctgggag gttgaggttg cggtgagtgg agatcacact actgcactcc 3481 agtctgggcg acagagtgag accctgtctc aaacaaaaca aaacaaaaac aaacaaacaa 3541 aaacaaaaaa aactcagttt cctcatccat aaaataggaa ttagatttca atgttctctt 3601 aggtcccttc tagctttaat tcatatgtga ttatgcagta accacaaggt attttttaaa 3661 cctcctaatg tatggatatt aagcagaaga gtatttatat gaatacatgt ttcacattcc 3721 tttggtatga aaatggtgtg ttaagttttt cctttaacca ctgagttgtg aatgtgaaga 3781 aggtggtgga gaggaacaaa aaacagaaag gtattttgat cttgccacaa agcatacaca 3841 caaattggca catgcagctg tttgccaaag ccttcttttt ttttttactt tttaagaaat 3901 tatgttaggg aaaataaatt ctgcttccag ggacaacttc atggagccta tttacaaatt 3961 aagagtcagc ttaatttgta acatttctac cagagccaag aatcccaaat tcctggtaga 4021 ttagtgtttt atttctaagg ggcttatgca ttcggctcca actcaactcg tctatgtgct 4081 gccagtaatt aaaatgttcc acctcagact gcacaaatgg cttatccttc tttgtggcat 4141 ggcgtctgtc tcaggaaaaa aggttttatg aaattccatg gcaacagtcc caacatgttt 4201 gagacttcag ctaaaggaat ggatgtattt tggtgtgtag tcttcagtat atcactgtat 4261 ttccgtaata ctagactcca agctatgcca gattgcttat tccctttgtg aaagaggagt 4321 tgctcattac gttcttgaaa tatcgcacat cctgttggtt cttcaaggga caagagaaag 4381 agaattLgga agcagggatt agtagaagag aaaacgaggg aaaggaagcc tttccaccag 4441 attagtgttc aagtctttgc agaggagacc aacttttttt gttttctttt gttttgagac 4501 agtctctcgc tctgctgccc aggctggagt gcagtggcgc gatctcggct cacggcaacc 4561 tccgcctccc gggttcaagc aattctcctg cctcagcctc ccaagtagct gggattacag 4621 gtgctcacca ccaagcccgg ctaattcttg tatttttagt agagacaagg tttcaccatg 4681 ttggccaggc cagtctcaaa ctcctgacct caggtgatct gcccgccttg gcctcccaca 4741 gtgctgggat tacaggcatg agctaccgca cccagcctga gaccaccttt tgcatctcaa 4801 gattgtgaaa ccaaggccca ttccaccagc ctggggactc tttttataga tatgatcctc 4861 ctttttcctg tgactaatga atttgctgca tgatttctat tcttctgagg ttagttttct 4921 gagtaaggtg accactcaca aaggcacttt ctttgtggca ttctgagcct agattggggc 4981 ccatcaattc cagaaaaaat ttatgtgtgg aaactctgca tcctcaagtc ttgaagttga 5041 accagatatg cagtggttac catcacacag ataaacgctg ccttctgtac atacccctta 5101 tgctgtacta attaacaaac cccttgccag ggctggggag gtgagggtga aggagaatct 5161 tagcagaagg gcagagtcag gacttgcatc tgccactgct gggcactgaa gccctggagc 5221 agcttcagat agtacctgta ctttctcatg cagactccct ctgaacaaga gccttgtagg 5281 cccctctcct tcatttccca ccagcctctt atcaggcggg ctttccacca tacacccagg 5341 aggccacggt ctgaggaaca accaaaccca tgcaaagggc cgggcgcgat agctcacgcc 5401 tgtaatgcca gcactttggg aggctggggc aggcagatca cctgaggttg ggagttcgag 5161 acctgcctga ccaacatgga gaaaccccca tctctactaa aaatacaaaa ttagccgggc 5521 gtgatggcac atgcctgtaa tcccagctac tcaggaggct gaggcaggag aatcgcttga 5581 acccgggagg cggaggttgc ggtgagccga gatggcacca ctgcactcca gcctcggcaa 5641 caagagcgaa actctgtcta aaacaaaaac aaacaaacaa acaaaaaaac ccaggcaaag 5701 tttcuttgca gccaaggtga cagaactggg ctgagggtgg aaaagaaaca gaaccagtgc 5761 tccaggtgtt ttttaatttt ttaatttatt tttatttttt ttgtatatgt atatatatgt 5821 atgtatattt tagaggacca gggtctcact atgttgccta ggccagactc aaactcctgt 5881 gctcaagcaa tcctgcctca gcctcccaag tagctgggat tacaggcatg cacaaacaat 5941 gcccagctct ccaaatgttt tctgtcacta cctgaagtgt tgcatcggta cttcctacgg 6001 aaagaaaact aaatagaagt gtctctcccg tgagccccca ccactaccac cagaaaaaaa 6061 aaagagagaa aatgaactca tcagtcttta gtttcctcaa gttattctcc caaaaagaca 6121 ttcgccttgg cacagataag ccagctaatc ttatgcttta tgacccactg tgagctgttc 6181 ctgacacagc ttctgacttt gtcagtgaca aaatttctca ccttttaaat gcagtgctta 6241 acattttgtt aggcccatac tcaaaatcgg ccagatataa aatgacctca gattttgatc 6301 tcctaggctc aaacaatcct cctacctcag cctcccaagt agctgggact ataggcacac 6361 caccatgcac agctaatttt ttttgtattt ttctgcagag atggcgtttc gccatactgc 6421 ccaggctagt ctcaaaatcc tgggctcaag caatctgccc acctcagcct cccaaagtgc 6481 tggaactaca ggcaagagcc actgcgccca gccacaacct cagatttctt tggcaaacag 6541 aaatgtttaa aaacacaaaa ttttgctcag gtgaaacact gtgttactat caaatctcac 6601 atccacataa agtttttctt ttcggctttg tttcgtgagg aacagacaga acaaagtttt 6661 tccaggtagc atctgtatca ctattattct cctatttcct gtaccacccc cacctcccca 6721 agccctactg aatgtgaggt ttagaatgtt ttaaggaggg tcaggtgcgg tggctcacgc 6781 ctgtaatccc agcactttgg gaggccaagg cgggcggatc acctgagttt gggagttcga 6841 gaccagcctg accaacatgg agaaaccctg tctctactaa aaatacaaaa ttagccaggc 6901 gtggtggcac atgcctgtaa tcccagctac ttaggaggct gaggcaggag aatcgcttga 6961 acccaggagg aggaggttgt ggtgagccga gatcgtgcca ttgcactcca gcctgggtga 7021 cagagtgaga ctccatctcg aaaaaaaaaa tacaaaaatt agctgggtgt ggtggtgcac 7081 acctgtaatc ccagctactc gggaggctga cgcaggagaa ttgcttgaac ctgggaggtg 7141 gaggttgcag tgagccgaga tcgcgccatt gcaatccagc ctggacaaca gagtgagact 7201 ccatctcaaa aaaaaaaaaa aaaagaatgt tttaaggaaa aaaatagtac tgttacatat 7261 aatcccaggt gataagacca caatggaaat gtttaagtcc tcactttaaa gagtacccca 7321 ctgagaagag gtatgttgga ctctagcaga gatttggaaa ctctgggaca ctcaagatgt 7381 gaaagagcct ggctatctga ggactcaaag agtcagcatc gggacttgtg agctcaagaa 7441 gagaaaaggg agtggtgaaa ctttgtccta aaagttagca ccaggaacag aagaaaaaaa 7501 cccgatatat agtgatacct catcttttag agaatgggaa gctatttttg tgttcacaca 7561 gaaagtatag ttcaaaaaac ctctatatcc agagttcaga caaggagaat gatttgagat 7621 ataagtgccg atgaaggagg tcaattttga tctgaaacca gcagctggac ctgggccacc 7681 tcaggaaaag gactctgttc tccaaggcag cacgactgaa tggttctgag aataagccag 7741 ggttcaggac tcctgaccct ttaggaccat ggactcagaa gagcctgaag gacaattgtg 7801 ggctttaaac ttctgagagc ttgtaaagta acacaagact gtgcctctcc cttgccccag 7861 ctgtagatag tctttgcccc accattgtta tgaagataca cagggttttg cagtttgaat 7921 aaattggata caagtttcct cttttttttt ttctttttga gacaaagtct cgctctgttt 7981 ccccaggctg agtgcagtgg cacaatcaag gcttacttgc cgcctcaacc tcctgggctc 8041 aagcaacgag ccatcctccc gtcttagcct cccaactagc tgagactaca ggcgtgggtc 8101 accacaccca gctaattttt gtactttttg tagagacagg gtctcaccat gttgcccagg 8161 ctggtcctga actcctgggc tcaagtaatc tgcccacctc agcctcccaa agtgttgggg 8221 ttacaggcgt gaggcaccgc ggctggcctg agtttcttct taatactgta tcacaattgt 8281 gggctgtctt atgtgttgat atcgattgag ctatttgaaa taggaatgtt aatgggtgta 8341 ttaaattttt gtaaggatat aacaatatct accttccaag gatgttgtga ggttttccat 8401 gattttgtat atgagctaat gttacctttg aggggtggtg tgcattatgt tggatgattg 8461 taaattttca gtggaaaatg taccgtgtcc taaatttaaa gacatgaaaa atatcccaag 8521 atcatactag atcataatag caattccttt acaaatgaat tatggaggta actgatctct 8581 aacagtttcc ttcatgttgt tttaatgcac aagggcagag gatctgctga cccttggaac 8641 cagcgtgagc taaccacgtg ctatagacac ttcatgttgt cgcacccagg gaagtcaaag 8701 cgctttgctc cctcactgtc tgtgagtcct cagccattag taccccaccc cccgctgctc 8761 caaaacttga gttatttcaa atgtttctca ctgttcatct ctccactgac cccactccag 8821 aaagcctgga gagagtccca agatgccacc caccttcccc aatccctcgc cacagatctg 8881 tgtctatctc acactctgta agtgccgctt tgcttcttcc tctcttgaaa agactgagaa 8941 cacacatttt aacatgttag gaaaatgggg cagcctaaaa aatgactgat cccaccgcca 9001 gtgactcatg tatactccag gctagcagac aaggcccttt ttggtgggcc tgcttccgtg 9061 ggttcacaga aaccaaatta ctgtgggttg caaagaatta gcaggtcatt tacaaagcag 9121 acatcccttc acccagactg tggttttgca tgctcaggtt ctcagtctat gagctttggt 9181 gcaggatcat tttggctact ggaaaaacca tagcttattt taaatttctg gttgccaaag 9241 ccaccacacg tgtggtctgt ggatgaccat tgtctgcaga atgacgagga aggaacagaa 9301 tgtggtttgg ggctcagggt ggccttccca ctgggaggga aggcgggagg gagccottgc 9361 cctgggtttt gacacagcct gtgctcacag cctctcctct catctgcatt tctcagaaat 9421 gccctccctg cccagtggtg actttccctc gtcactccta tggagttcta cctggagccc 9481 agccatgtgt ggaactgtga agtttactcc tctgtaaaga tggtttaaag aaagtcagct 9541 tctgaaatgt aacaatgcta acccttgctg gaaccctgta agaaatagcc ctgctgatag 9601 ttttctaggt ttatcatgtt tgatttttac actgaaaaat aaaaaaatcc tggtatgttt 9661 gaaattaaaa aaaaaaaaaa aaaaaa

By “human CRBN polypeptide” is meant an amino acid sequence or fragment thereof having at least 85% amino acid sequence identity to NCBI Accession No. AAH67811.1 or NP_01166953.1 and having IKZF3 binding activity. Exemplary CRBN polypeptide sequences are provided below:

AAF167811.1 1 magegdqqda ahnmgnhlpl lpeseeedem evedqdskea kkpniinfdt slptshtylg 61 admeefhgrt lhdddscqvi pvlpqvmmil ipgqtlplql fhpqevsmvr nliqkdrtfa 121 vlaysnvqer eaqfgttaei yayreeqdfg ieivkvkaig rqrfkvlelr tqsdgiqqak 181 vqilpecvlp stmsavqles lnkcqifpsk pvsredqcsy kwwqkyqrrk fhcanltswp 241 rwlyslydae tlmdrikkql rewdenlkdd slpsnpidfs yrvaaclpid dvlriqllki 301 gsaiqrlrce ldimnkctsl cckqcqetei ttkneifsls lcgpmaayvn phgyvhetlt 361 vykacnlnli grpstehswf pgyawtvaqc kicashigwk ftatkkdmsp qkfwgltrsa 421 llptipdted eispdkvilc l NP_001166953.1 1 magegdqqda ahnmgnhlpl lpeseeedem evedqdskea kkpniinfdt slptshtylg 61 admeefhgrt lhdddscqvi pvlpqvmmil ipgqtlplql fhpqevsmvr nliqkdrtfa 121 vlaysnvqer eaqfgttaei yayreeqdfg ieivkvkaig rqrfkvlelr tqsdgiqqak 181 vgilpecvlp stmsavqles lnkcqifpsk pvsredqcsy kwwqkyqkrk fhcanltswp 241 rwlyslydae tlmdrikkql rewdenlkdd slpsnpidfs yrvaaclpid dvlriqllki 301 gsaiqrlrce ldimnkctsl cckqcqetei ttkneifsls lcgpmaayvn phgyvhetlt 361 vykacnlnli grpstehswf pgyawtvaqc kicashigwk ftatkkdmsp gkfwgltrsa 421 llptipdted eispdkvilc l

By “human CRBN polynucleotide” is meant a nucleic acid molecule encoding a CRBN polypeptide. An exemplary CRBN polynucleotide sequence is provided at NCBI Accession No. BC067811, which is reproduced below:

1 gcgtgtaaac agacatggcc ggcgaaggag atcagcagga cgctgcgcac aacatgggca 61 accacctgcc gctcctgcct gagagtgagg aagaagatga aatggaagtt gaagaccagg 121 atagtaaaga agccaaaaaa ccaaacatca taaattttga caccagtctg ccgacatcac 181 atacatacct aggtgctgat atggaagaat ttcatggcag gactttgcac gatgacgaca 241 gctgtcaggt gattccagtt cttccacaag tgatgatgat cctgattccc ggacagacat 301 tacctcttca gctttttcac cctcaagaag tcagtatggt gcggaattta attcagaaag 361 atagaacctt tgctgttctt gcatacagca atgtacagga aagggaagca cagtttggaa 421 caacagcaga gatatatgcc tatcgagaag aacaggattt tggaattgag atagtgaaag 481 tgaaagcaat tggaagacaa aggttcaaag tccttgagct aagaacacag tcagatggaa 541 tccagcaagc taaagtgcaa attcttcccg aatgtgtgtt gccttcaacc atgtctgcag 601 ttcaattaga atccctcaat aagtgccaga tatttccttc aaaacctgtc tcaagagaag 661 accaatgttc atataaatgg tggcagaaat accagaggag aaagtttcat tgtgcaaatc 721 taacttcatg gcctcgctgg ctgtattcct tatatgatgc tgagacctta atggacagaa 781 tcaagaaaca gctacgtgaa tgggatgaaa atctaaaaga tgattctctt ccttcaaatc 841 caatagattt ttcttacaga gtagctgctt gtcttcctat tgatgatgta ttgagaattc 901 agctccttaa aattggcagt gctatccagc gacttcgctg tgaattagac attatgaata 961 aatgtacttc cctctgctgt aaacaatgtc aagaaacaga aataacaacc aaaaatgaaa 1021 tattcagttt atccttatgt gggccgatgg cagcttatgt gaatcctcat ggatatgtgc 1081 atgagacact tactgtgtat aaggcttgca acttgaatct gataggccgg ccttctacag 1141 aacacagctg gtttcctggg tatgcctgga ctgttgccca gtgtaagatc tgtgcaagcc 1201 atattggatg gaagtttacg gccaccaaaa aagacatgtc acctcaaaaa ttttggggct 1261 taacgcgatc tgctctgttg cccacgatcc cagacactga agatgaaata agtccagaca 1321 aagtaatact ttgcttgtaa acagatgtga tagagataaa gttagttatc taacaaattg 1381 gttatattct aagatctgct ttggaaatta ttgcctctga tacataccta agtaaacata 1441 acattaatac ctaagtaaac ataacattac ttggagggtt gcagtttcta agtgaaactg 1501 tatttgaaac ttttaagtat actttaggaa acaagcatga acggcagtct agaataccag 1561 aaacatctac ttgggtagct tggtgccatt atcctgtgga atctgatatg tctggtagcg 1621 tgtcattgat gggacatgaa gacatctttg gaaatgatga gattatttcc tgtgttaaaa 1681 aaaaaaaaaa aatcttaaat tcctacaatg tgaaactgaa actaataatt tgatcctgat 1741 gtatgggaca gcgtatctgt accagtgctc taaataacaa aagctagggt gacaagtaca 1801 tgttcctttt ggaaagaagc aaggcaatgt atattaatta ttctaaaagg gctttgttcc 1861 tttccatttt ctttaacttc tctgagatac tgatttgtaa attttgaaaa ttagttaaaa 1921 tatgcagttt tttgagccca cgaatagttg tcatttcctt tatgtgcctg ttagtaaaaa 1981 gtagtattgt gtatttgctc agtatctgaa ctataagccc atttatactg ttccatacaa 2041 aagctatttt tcaaaaatta atttgaacca aaactactac tatagggaaa agatgccaaa 2101 acatgtcccc tcacccaggc taaacttgat actgtattat tttgttcaat gtaaattgaa 2161 gaaaatctgt aagtaagtaa accttaagtg tgaaactaaa aaaaaaaaaa aaa

By “murine CRBN polypeptide” is meant an amino acid sequence or fragment thereof having at least 85% amino acid sequence identity to NCBI Accession No. BC086488.1 or NP_67424 and having IKZF3 binding activity. Exemplary CRBN polypeptide sequence is provided below:

BC086488.1 1 mgnhlpllpd sededdeiem evedqdskea rkpniinfdt slptshtylg admeefhgrt 61 lhdddscqvi pvlpevlmil ipgqtlplql shpqevsmvr nliqkdrtfa vlaysnvqer 121 eaqfgttaei yayreeqefg ievvkvkaig rqrfkvlelr tqsdgiqqak vqilpecvlp 181 stmsavqves lnkcqvfpsk piswedqysc kwwqkyqkrk fhcanltswp rwlyslydae 241 tlmdrikkql rewdenlkdd slpenpidfs yrvaaclpid dvlriqllki gsaiqrlrce 301 ldimnkctsl cckqcqetei ttkneifsls lcgpmaayvn phgyvhetlt vykasnlnli 361 grpstvhswf pgyawtiaqc kicashigwk ftatkkdmsp qkfwgltrsa llptipeted 421 eispdkvilc l NP_067424 1 magegdqqda ahnmgnhlpl lpadsededd eiemevedqd skearkpnii nfdtslptsh 61 tylgadmeef hgrtlhddds cqvipvlpev lmilipgqtl plqlshpqev smvrnliqkd 121 rtfavlaysn vqereaqfgt taeiyayree qefgievvkv kaigrqrfkv lelrtqsdgi 181 qqakvqilpe cvlpstmsav qleslnkcqv fpskpiswed qysckwwqky qkrkfhcanl 241 tswprwlysl ydaetlmdri kkqlrewden lkddslpenp idfsyrvaac lpiddvlriq 301 llkigsaiqr lrceldimnk ctslcckqcq eteittknei fslslcgpma ayvnphgyvh 361 etltvykasn lnligrpstv hswfpgyawt iaqckicash igwkftatkk dmspqkfwgl 421 trsallptip etedeispdk vilcl

By “murine CRBN polynucleotide” is meant a nucleic acid molecule encoding a murine CRBN polypeptide. An exemplary murine CRBN polynucleotide sequence is provided at NCBI Accession No. NM_021449 or NM_175357, which are reproduced below:

NM_021449 1 tttcccaggc tcctttgcgg gtaaacagac atggccggcg agggagatca gcaggacgct 61 gcgcacaaca tgggaaacca cctgccgctt ctgcctgaca gtgaagatga agatgatgaa 121 attgaaatgg aagttgaaga ccaagatagt aaagaagcca gaaaaccgaa tatcataaac 181 tttgacacca gtctgccaac ctcacataca tacctgggag ctgatatgga ggagttccac 241 gggagaactt tgcatgacga cgacagctgc caggtgatcc cagtccttcc tgaggtgctg 301 atgatcctga ttcctgggca gacactccca ctgcaqctct ctcacccaca ggaagtcagc 361 atggtgcgga acttaatcca gaaagacagg acctttgcag tccttgcata cagtaatgtg 421 caagaaaggg aagcacagtt tgggacaaca gcagagatct atgcctatcg agaagagcag 481 gagtttggaa ttgaagtagt gaaagtgaaa gcaattggaa ggcagcggtt caaggtcctc 541 gaacttcgaa cacagtcaga tggaatccag caagctaaag tgcagatttt gccagagtgt 601 gtgttgccgt caaccatgtc tgcagtgcag ttagaatcac tcaataagtg ccaggtattt 661 ccttcaaaac ccatctcctg ggaagaccag tattcatgta aatggtggca gaaataccag 721 aagagaaagt ttcactgtgc aaatctaaca tcatggcctc gctggctgta ttcattatat 781 gatgctgaaa cattaatgga tagaattaag aaacagctac gtgaatgqqa tgaaaatctc 841 aaagatgatt ctcttcctga aaatccaata gacttttctt acagagtagc tgcttgtctt 901 cctattgatg atgtattgag aattcagctc cttaaaatcg gcagtgctat tcaacggctt 961 cgctgtgaat tggacatcat gaacaaatgt acttcccttt gctgtaaaca atgtcaagaa 1021 acagaaataa cgacaaagaa tgaaatattt agtttatcct tatgtggtcc aatggcagca 1081 tatgtgaatc ctcatggata tgtacatgag acactgactg tgtataaagc gtccaacctg 1141 aatctgatag gccggccttc tacagtgcac agctggtttc ccgggtatgc atggaccatt 1201 gcccagtgca agatctgtgc aaqccatatt ggatggaaat ttacagccac aaaaaaagac 1261 atgtcacctc aaaaattttg gggcttaact cgctctgctc tgttacccac aattccagag 1321 actgaagatg aaataagtcc agacaaagta atactttgtt tataagtgca cctgtaggag 1381 tgacttcctg acagatattt cctcaagtca gatctgccca gtcatcactg cctctgatat 1441 atgtgtatag tgggttacag catttgccta ccaagttcaa gagcatattt agggaatgag 1501 aaagcagtat aaaacataag gctgggttcc aaaatacttg ctttttagta gcttggtgcc 1561 atggattatc ctgttgagtc tatgtcatga caggatagga aaacacagtt gaaataatgg 1621 gaatggccat ggaacaggat aggggcacca ctgctctaaa tgatgaagct ctaaatgatg 1681 aatgctccag aaactgggtt ggtaagcaca agatagaggc aaggcagtgt aattttaaaa 1741 ggactttgct cctttcaatt ttccttagct tgtctgagat actgacctgt acattttgaa 1801 catattaaag agtaactaag tattctgagc agaaatagca gcatttggtg tagttgcact 1861 tttgatttga tgagcctgtg atgtgctaga tccctttaac taatgtatat gtccattttg 1921 cattttattt gcaaatataa gtgaacagta tatatttcta ggattatacc atttaggaaa 1981 caggtttaca taaacataaa tatccaaatc tattctattt ggctgaatta tgtcaaagta 2041 atcaagtaga atactgaaaa gtgtaagtac gtaataaaat gcaactcaag aataggctgc 2101 tccttaatgt cattttttca aaagttctac ttgtqtttca ttcaagctgc tgtgatggag 2161 tggggaatta tgcctttact gctgcagtat aatctqatga tccatggact gtttaccatt 2221 actttcagat aggactgttt aaaggaatct tacacaatat agcagctttg atgtcactcc 2281 atctgtgcag atgacaacag cagaaactcc atagtttaaa atccaggtat ttactgacct 2341 gggtgaagta gattttgaca cgccctttta tagcacatca ccttatttga cttcaagaaa 2401 attcaaaatc caaaagctgc tgtttacttg tacagtacac agatatctat gagcagctat 2461 gcagtaagta actatgtaag ctatcagaaa gctaagccat atccatctaa cttgtaaaat 2521 aaacaacgtg ttcactatct gtggcacctg atataaaggc aagagtctca gcacaagccc 2581 tcctgttatt cctgcaactt tctgaaatca gaacaatcct gttataaata gatgctacta 2641 tggactcatt caggaaacca ctaagaaaac atagettcec ttcaacagtt actacatttt 2701 aagatcaaca gcactgctcc acaagcattg ggaaattcag gaggtagact tgagcttagt 2761 ttttctacct acactcatgc tggttctggg gtctcagtaa cacaggaggg gagaacacca 2821 gccttaccaa gacttcccct gtttcataca gggctcatct ttaggtcttc tttatgtaac 2881 ttagtagttc atctttttcc atccggtaac cacttttctt ccactgttca cgcaactgct 2941 gtagcagggc cccaatttcc ttccctgaag aaatacccac tttcctgatg tcatgtccac 3001 tcacagggaa cggcgggaca gaccactgct gcatctcttt gagaagacca tgctctcctt 3061 ggtacttcag cagctcacaa acacgggcag ttgcatctgg ttccctagac taaatgacac 3121 agttttatca catactaaac actcacaatt tcattctact atttaaatac ttacatcaaa 3181 totacagtgt gaaaaagtta cttttctcta gttagtgaga actattttct gctcagacct 3241 aatacatact tacgtctatc acaaagtctt ggtatggttt caatggttct gaactatctg 3301 ttgctttaat caagtctttc ctgtttttaa ctataaataa acccaggttt ttctcctctt 3361 ttgaaatttt caatctcaag tccaattttg tgacatcatc ttgtactttg aataaagaag 3421 ccaaaagagt cattggtttt ggtgaaaagc cttcaacatt tttactgact ttgttaaatt 3481 cttctaaatt tgcattagca ggtaaacctg taaacaaaag agaaaagtca tttttttctt 3541 aactacaaaa ccctcactca cctcttaaac tatgcagatt tttaagaatg tgtagtgttc 3601 tttctccact gcttattatc agcccattcg tcactccctt aactcctaga agaaatctat 3661 catgttcctg tttcctgtag cagcatgtct tgtgaagctc aggagctgtg atcatatcag 3721 gtaccagcat atgccttctc agtcatgatc ctgtctgcac acattcccta ctcagcaatt 3781 gtatgttctt gtaaaacagt caaagttact gtctaaaata tactggctat agttattaat 3841 ttcctttcta tatattaagt gttttgtgaa agagcttatt atacattaac ttattgcttc 3901 atcctcctct ctatgaagta gcttttattt tgaacccttt gtgattataa accaacccaa 3961 cctgcaaaac cagtaagctt catcaaattc aggtgttctc tctgaactat tctttaccaa 4021 taaataaact atttccatct ttaatcccaa aaaaaaaaaa aaaa NM_175357 1 tttcccaggc tcctttgcgg gtaaacagac atggccggcg agggagatca gcaggacgct 61 gcgcacaaca tgggaaacca cctgccgctt ctgcctgcag acagtgaaga tgaagatgat 121 gaaattgaaa tggaagttga agaccaagat agtaaagaag ccagaaaacc gaatatcata 181 aactttgaca ccagtctgcc aacctcacat acatacctgg gagctgatat ggaggagttc 241 cacgggagaa ctttgcatga cgacgacagc tgccaggtga tcccagtcct tcctgaggtg 301 ctgatgatcc tgattcctgg gcagacactc ccactgcagc tctctcaccc acaggaagtc 361 agcatggtgc ggaacttaat ccagaaagac aggacctttg cagtccttgc atacagtaat 421 gtgcaagaaa gggaagcaca gtttgggaca acagcagaga tctatgccta tcgagaagag 481 caggagtttg gaattgaagt agtgaaagtg aaagcaattg gaaggcagcg gttcaaggtc 541 ctcgaacttc gaacacagtc agatggaatc cagcaagcta aagtgcagat tttgccagag 601 tgtgtgttgc cgtcaaccat gtctgcagtg cagttagaat cactcaataa gtgccaggta 661 tttccttcaa aacccatctc ctgggaagac cagtattcat gtaaatggtg gcagaaatac 721 cagaagagaa agtttcactg tgcaaatcta acatcatggc ctcgctggct gtattcatta 781 tatgatgctg aaacattaat ggatagaatt aagaaacagc tacgtgaatg ggatgaaaat 841 ctcaaagatg attctcttcc tgaaaatcca atagactttt cttacagagt agctgcttgt 901 cttcctattg atgatgtatt gagaattcag ctccttaaaa tcggcagtgc tattcaacgg 961 cttcgctgtg aattggacat catgaacaaa tgtacttccc tttgctgtaa acaatgtcaa 1021 gaaacagaaa taacgacaaa gaatgaaata tttagtttat ccttatgtgg tccaatggca 1081 gcatatgtga atcctcatgg atatgtacat gagacactga ctgtgtataa agcgtccaac 1141 ctgaatctga taggccggcc ttctacagtg cacagctggt ttcccgggta tgcatggacc 1201 attgcccagt gcaagatctg tgcaagccat attggatgga aatttacagc cacaaaaaaa 1261 gacatgtcac ctcaaaaatt ttggggctta actcgctctg ctctgttacc cacaattcca 1321 gagactgaag atgaaataag tccagacaaa gtaatacttt gtttataagt gcacctgtag 1381 gagtgacttc ctgacagata tttcctcaag tcagatctgc ccagtcatca ctgcctctga 1441 tatatgtgta tagtgggtta cagcatttgc ctaccaagtt caagagcata tttagggaat 1501 gagaaagcag tataaaacat aaggctgggt tccaaaatac ttgcttttta gtagcttggt 1561 gccatggatt atcctgttga gtctatgtca tgacaggata ggaaaacaca gttgaaataa 1621 tgggaatggc catggaacag gataggggca ccactgctct aaatgatgaa gctctaaatg 1681 atgaatgctc cagaaactgg gttggtaagc acaagataga ggcaaggcag tgtaatttta 1741 aaaggacttt gctcctttca attttcctta gcttgtctga gatactgacc tgtacatttt 1801 gaacatatta aagagtaact aagtattctg agcagaaata gcagcatttg gtgtagttgc 1861 acttttgatt tgacgagcct gtgatgtgct agatcccttt aactaatgta tatgtccatt 1921 ttgcatttta tttgcaaata taagtgaaca gtatatattt ctaggattat accatttagg 1981 aaacaggttt acataaacat aaatatccaa atctattcta tttggctgaa ttatgtcaaa 2041 gtaatcaagt agaatactga aaagtgtaag tacgtaataa aatgcaactc aagaataggc 2101 tgctccttaa tgtcattttt tcaaaagttc tacttgtgtt tcattcaagc tgctgtgatg 2161 gagtggggaa ttatgccttt actgctgcag tataatctga tgatccatgg actgtttacc 2221 attactttca gataggactg tttaaaggaa tcttacacaa tatagcagct ttgatgtcac 2281 tccatctgtg cagatgacaa cagcagaaac tccatagttt aaaatccagg tatttactga 2341 cctgggtgaa gtagattttg acacgccctt ttatagcaca tcaccttatt tgacttcaag 2401 aaaattcaaa atccaaaagc tgctgtttac ttgtacagta cacagatatc tatgagcagc 2461 tatgcagtaa gtaactatgt aagctatcag aaagctaagc catatccatc taacttgtaa 2521 aataaacaat gtgttcacta tctgtggcac ctqatataaa ggcaagagtc tcagcacaag 2581 ccctcctgtt attcctgcaa ctttctgaaa tcagaacaat cctgttataa atagatgcta 2641 ctatggactc attcaggaaa ccactaagaa aacatagttt ctcttcaaca gttactacat 2701 tttaagatca acagcactgc tccacaagca ttgggaaatt caggaggtag acttgagctt 2761 agtttttcta cctacactca tgctggtttt ggggtctcag taacacagga ggggagaaca 2821 ccagccttac caagacttcc cctgtttcat acagggctca tctttaggtc ttctttatgt 2881 aacttagtag ttcatctttt tccatccggt aaccactttt cttccactgt tcacgcaact 2941 gctgtagcag ggccccaatt tccttccctg aagaaatacc cactttcctg atgtcatgtc 3001 cactcacagg gaacggcggg acagaccact gctgcatctc tttgagaaga ccatgctctc 3061 cttggtactt cagcagctca caaacacggg cagttgcatc tggttcccta gactaaatga 3121 cacagtttta tcacatacta aacactcaca atttcattct actatttaaa tacttacatc 3181 aaatctacag tgtgaaaaag ttacttttct ctagttagtg agaactattt tctgctcaga 3241 cctaatacat acttacgtct atcacaaagt cttggtatgg tttcaatggt tctgaactat 3301 ctgttgcttt aatcaagtct ttcctgtttt taactataaa taaacccagg tttttctcct 3361 cttttgaaat tttcaatctc aagtccaatt ttgtgacatc atcttgtact ttgaataaag 3421 aagccaaaag agtcattggt tttggtgaaa agccttcaac atttttactg actttgttaa 3481 attcttctaa atttgcatta gcaggtaaac ctgtaaacaa aagagaaaag tcattttttt 3541 cttaactaca aaaccctcac tcacctctta aactatgcag atttttaaga atgtgtagtg 3601 ttctttctcc actgcttatt atcagcccat tcgtcactcc cttaactcct agaagaaatc 3661 tatcatgttc ctgtttcctg tagcagcatg tcttgtgaag ctcaggagct gtgatcatat 3721 caggtaccag catatgcctt ctcagtcatg atcctgtctg cacacattcc ctactcagca 3781 attgtatgtt cttgtaaaac agtcaaagtt actgtctaaa atatactggc tatagttatt 3841 aatttccttt ctatatatta agtgttttgt gaaagagctt attatacatt aacttattgc 3901 ttcatcctcc tctctatgaa gtagctttta ttttgaaccc tttgtgatta taaaccaacc 3961 caacctgcaa aaccagtaag cttcatcaaa ttcaggtgtt ctctctgaac tattctttac 4021 caataaataa actatttcca tctttaatcc caaaaaaaaa aaaaaaa

By “casein kinase 1A1 polypeptide” is meant a protein having at least about 85% or greater identity to Unit Pro Accession No. P48729-1 or P48729-2 (having a phosphor serine at position 156) and having kinase activity.

        10         20         30         40         50         60 MASSSGSKAE FIVGGKYKLV RKIGSGSFGD IYLAINITNG EEVAVKLESQ KARHPQLLYE         70         80         90        100        110        120 SKLYKILQGG VGIPHIRWYG QEKDYNVLVM DLLGPSLEDL FNFCSRRFTM KTVLMLADQM        130        140        150        160        170        180 ISRIEYVHTK NFIHRDIKPD NFLMGIGRHC NKLFLIDFGL AKKYRDNRTR QHIRYREDKN        190        200        210        220        230        240 LTGTARYASI NAHLGIEQSR RDDMESLGYV LMYFNRTSLP WQGLKAATKK QKYEKISEKK        250        260        270        280        290        300 MSTPVEVLCK GFPAEFAMYL NYCRGLRFEE APDYMYLRQL FRILFRTLNH QYDYTFDWTM        310        320        330 LKQKAAQQAA SSSGQGQQAQ TPTGKQTDKT KSNMKGF

By “casein kinase 1A1 polynucleotide” is meant a polynucleotide encoding a casein kinase 1A1 polypeptide.

By “B cell neoplasia” is meant any neoplasia arising from a B-cell progenitor or other cell of B cell lineage. In particular embodiments, a B cell neoplasia arises from a cell type undergoing B cell differentiation. In other embodiments, a B cell neoplasia includes plasma cells.

By “mutant CRBN” is meant any mutation of murine CRBN to include at least one of S369C, V380E, I391V, or any other substitution, deletion or addition of the murine CRBN that confers lenalidomide sensitivity to CSNK1A1.

By “myeloid malignancy” is meant a condition associated with a defect in the proliferation of a hematopoietic cell. Myelodysplastic syndrome with deletion of 5q.

By “agent” is meant any small molecule chemical compound, antibody, nucleic acid molecule, or polypeptide, or fragments thereof.

By “ameliorate” is meant decrease, suppress, attenuate, diminish, arrest, or stabilize the development or progression of a disease.

By “alteration” is meant a change. In one embodiment, an alteration characterized in accordance with the methods of the invention is a change in the sequence of a polypeptide or polynucleotide. In another embodiment, an alteration characterized in accordance with the methods of the invention is an increase or decrease in the level, biological activity, or post-transcriptional modification of a polypeptide (e.g., IKZF1, IKZF3) as detected by standard art known methods such as those described herein. As used herein, an alteration includes 10%, 25%, 50%, 75%, 85%, 95% or greater increase or decrease in level or biological activity.

By “lenalidomide sensitivity” is meant that at least one symptom of a pathological condition is ameliorated by treatment with lenalidomide or a lenalidomide analog.

By “lenalidomide resistant” is meant that a neoplastic cell has acquired an alteration that allows it to escape an anti-neoplastic effect of lenalidomide. Exemplary anti-neoplastic effects include, but are not limited to, any effect that reduces proliferation, reduces survival, and/or increases cell death (e.g., increases apoptosis).

By “analog” is meant a molecule that is not identical, but has analogous functional or structural features. Lenalidomide analogs include, but are not limited to, thalidomide or pomalidomide. By “biological sample” is meant any liquid, cell, or tissue obtained from a subject.

In this disclosure, “comprises,” “comprising,” “containing” and “having” and the like can have the meaning ascribed to them in U.S. patent law and can mean “includes,” “including,” and the like; “consisting essentially of” or “consists essentially” likewise has the meaning ascribed in U.S. patent law and the term is open-ended, allowing for the presence of more than that which is recited so long as basic or novel characteristics of that which is recited is not changed by the presence of more than that which is recited, but excludes prior art embodiments.

“Detect” refers to identifying the presence, absence or amount of the analyte to be detected.

By “detectable label” is meant a composition that when linked to a molecule of interest renders the latter detectable, via spectroscopic, photochemical, biochemical, immunochemical, or chemical means. For example, useful labels include radioactive isotopes, magnetic beads, metallic beads, colloidal particles, fluorescent dyes, electron-dense reagents, enzymes (for example, as commonly used in an ELISA), biotin, digoxigenin, or haptens.

By “effective amount” is meant the amount of an agent required to ameliorate the symptoms of a disease relative to an untreated patient. The effective amount of active compound(s) used to practice the present invention for therapeutic treatment of a disease varies depending upon the manner of administration, the age, body weight, and general health of the subject. Ultimately, the attending physician or veterinarian will decide the appropriate amount and dosage regimen. Such amount is referred to as an “effective” amount.

By “fragment” is meant a portion of a polypeptide or nucleic acid molecule. This portion contains, preferably, at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90% of the entire length of the reference nucleic acid molecule or polypeptide. A fragment may contain 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100, 200, 300, 400, 500, 600, 700, 800, 900, or 1000 nucleotides or amino acids.

The invention provides a number of targets that are useful for the development of highly specific drugs to treat or a disorder characterized by the methods delineated herein. In addition, the methods of the invention provide a facile means to identify therapies that are safe for use in subjects. In addition, the methods of the invention provide a route for analyzing virtually any number of compounds for effects on a disease described herein with high-volume throughput, high sensitivity, and low complexity.

By “inhibitory nucleic acid” is meant a double-stranded RNA, siRNA, shRNA, or antisense RNA, or a portion thereof, or a mimetic thereof, that when administered to a mammalian cell results in a decrease (e.g., by 10%, 25%, 50%, 75%, or even 90-100%) in the expression of a target gene. Typically, a nucleic acid inhibitor comprises at least a portion of a target nucleic acid molecule, or an ortholog thereof, or comprises at least a portion of the complementary strand of a target nucleic acid molecule. For example, an inhibitory nucleic acid molecule comprises at least a portion of any or all of the nucleic acids delineated herein.

The terms “isolated,” “purified,” or “biologically pure” refer to material that is free to varying degrees from components which normally accompany it as found in its native state. “Isolate” denotes a degree of separation from original source or surroundings. “Purify” denotes a degree of separation that is higher than isolation. A “purified” or “biologically pure” protein is sufficiently free of other materials such that any impurities do not materially affect the biological properties of the protein or cause other adverse consequences. That is, a nucleic acid or peptide of this invention is purified if it is substantially free of cellular material, viral material, or culture medium when produced by recombinant DNA techniques, or chemical precursors or other chemicals when chemically synthesized. Purity and homogeneity are typically determined using analytical chemistry techniques, for example, polyacrylamide gel electrophoresis or high performance liquid chromatography. The term “purified” can denote that a nucleic acid or protein gives rise to essentially one band in an electrophoretic gel. For a protein that can be subjected to modifications, for example, phosphorylation or glycosylation, different modifications may give rise to different isolated proteins, which can be separately purified.

By “isolated polynucleotide” is meant a nucleic acid (e.g., a DNA) that is free of the genes which, in the naturally-occurring genome of the organism from which the nucleic acid molecule of the invention is derived, flank the gene. The term therefore includes, for example, a recombinant DNA that is incorporated into a vector; into an autonomously replicating plasmid or virus; or into the genomic DNA of a prokaryote or eukaryote; or that exists as a separate molecule (for example, a cDNA or a genomic or cDNA fragment produced by PCR or restriction endonuclease digestion) independent of other sequences. In addition, the term includes an RNA molecule that is transcribed from a DNA molecule, as well as a recombinant DNA that is part of a hybrid gene encoding additional polypeptide sequence.

By an “isolated polypeptide” is meant a polypeptide of the invention that has been separated from components that naturally accompany it. Typically, the polypeptide is isolated when it is at least 60%, by weight, free from the proteins and naturally-occurring organic molecules with which it is naturally associated. Preferably, the preparation is at least 75%, more preferably at least 90%, and most preferably at least 99%, by weight, a polypeptide of the invention. An isolated polypeptide of the invention may be obtained, for example, by extraction from a natural source, by expression of a recombinant nucleic acid encoding such a polypeptide; or by chemically synthesizing the protein. Purity can be measured by any appropriate method, for example, column chromatography, polyacrylamide gel electrophoresis, or by HPLC analysis.

By “marker” or “biomarker” is meant any protein or polynucleotide having an alteration in expression level or activity that is associated with a disease or disorder.

As used herein, “obtaining” as in “obtaining an agent” includes synthesizing, purchasing, or otherwise acquiring the agent.

By “reference” is meant a standard or control condition.

A “reference sequence” is a defined sequence used as a basis for sequence comparison. A reference sequence may be a subset of or the entirety of a specified sequence; for example, a segment of a full-length cDNA or gene sequence, or the complete cDNA or gene sequence. For polypeptides, the length of the reference polypeptide sequence will generally be at least about 16 amino acids, preferably at least about 20 amino acids, more preferably at least about 25 amino acids, and even more preferably about 35 amino acids, about 50 amino acids, or about 100 amino acids. For nucleic acids, the length of the reference nucleic acid sequence will generally be at least about 50 nucleotides, preferably at least about 60 nucleotides, more preferably at least about 75 nucleotides, and even more preferably about 100 nucleotides or about 300 nucleotides or any integer thereabout or therebetween.

Nucleic acid molecules useful in the methods of the invention include any nucleic acid molecule that encodes a polypeptide of the invention or a fragment thereof. Such nucleic acid molecules need not be 100% identical with an endogenous nucleic acid sequence, but will typically exhibit substantial identity. Polynucleotides having “substantial identity” to an endogenous sequence are typically capable of hybridizing with at least one strand of a double-stranded nucleic acid molecule. Nucleic acid molecules useful in the methods of the invention include any nucleic acid molecule that encodes a polypeptide of the invention or a fragment thereof. Such nucleic acid molecules need not be 100% identical with an endogenous nucleic acid sequence, but will typically exhibit substantial identity. Polynucleotides having “substantial identity” to an endogenous sequence are typically capable of hybridizing with at least one strand of a double-stranded nucleic acid molecule. By “hybridize” is meant pair to form a double-stranded molecule between complementary polynucleotide sequences (e.g., a gene described herein), or portions thereof, under various conditions of stringency. (See, e.g., Wahl, G. M. and S. L. Berger (1987) Methods Enzymol. 152:399; Kimmel, A. R. (1987) Methods Enzymol. 152:507).

For example, stringent salt concentration will ordinarily be less than about 750 mM NaCl and 75 mM trisodium citrate, preferably less than about 500 mM NaCl and 50 mM trisodium citrate, and more preferably less than about 250 mM NaCl and 25 mM trisodium citrate. Low stringency hybridization can be obtained in the absence of organic solvent, e.g., formamide, while high stringency hybridization can be obtained in the presence of at least about 35% formamide, and more preferably at least about 50% formamide. Stringent temperature conditions will ordinarily include temperatures of at least about 30° C., more preferably of at least about 37° C., and most preferably of at least about 42° C. Varying additional parameters, such as hybridization time, the concentration of detergent, e.g., sodium dodecyl sulfate (SDS), and the inclusion or exclusion of carrier DNA, are well known to those skilled in the art. Various levels of stringency are accomplished by combining these various conditions as needed. In a preferred: embodiment, hybridization will occur at 30° C. in 750 mM NaCl, 75 mM trisodium citrate, and 1% SDS. In a more preferred embodiment, hybridization will occur at 37° C. in 500 mM NaCl, 50 mM trisodium citrate, 1% SDS, 35% formamide, and 100.mu.g/ml denatured salmon sperm DNA (ssDNA). In a most preferred embodiment, hybridization will occur at 42° C. in 250 mM NaCl, 25 mM trisodium citrate, 1% SDS, 50% formamide, and 200 μg/ml ssDNA. Useful variations on these conditions will be readily apparent to those skilled in the art.

For most applications, washing steps that follow hybridization will also vary in stringency. Wash stringency conditions can be defined by salt concentration and by temperature. As above, wash stringency can be increased by decreasing salt concentration or by increasing temperature. For example, stringent salt concentration for the wash steps will preferably be less than about 30 mM NaCl and 3 mM trisodium citrate, and most preferably less than about 15 mM NaCl and 1.5 mM trisodium citrate. Stringent temperature conditions for the wash steps will ordinarily include a temperature of at least about 25° C., more preferably of at least about 42° C., and even more preferably of at least about 68° C. In a preferred embodiment, wash steps will occur at 25° C. in 30 mM NaCl, 3 mM trisodium citrate, and 0.1% SDS. In a more preferred embodiment, wash steps will occur at 42 C in 15 mM NaCl, 1.5 mM trisodium citrate, and 0.1% SDS. In a more preferred embodiment, wash steps will occur at 68° C. in 15 mM NaCl, 1.5 mM trisodium citrate, and 0.1% SDS. Additional variations on these conditions will be readily apparent to those skilled in the art. Hybridization techniques are well known to those skilled in the art and are described, for example, in Benton and Davis (Science 196:180, 1977); Grunstein and Hogness (Proc. Natl. Acad. Sci., USA 72:3961, 1975); Ausubel et al. (Current Protocols in Molecular Biology, Wiley Interscience, New York, 2001); Berger and Kimmel (Guide to Molecular Cloning Techniques, 1987, Academic Press, New York); and Sambrook et al., Molecular Cloning: A Laboratory Manual, Cold Spring Harbor Laboratory Press, New York.

By “substantially identical” is meant a polypeptide or nucleic acid molecule exhibiting at least 50% identity to a reference amino acid sequence (for example, any one of the amino acid sequences described herein) or nucleic acid sequence (for example, any one of the nucleic acid sequences described herein). Preferably, such a sequence is at least 60%, more preferably 80% or 85%, and more preferably 90%, 95% or even 99% identical at the amino acid level or nucleic acid to the sequence used for comparison.

Sequence identity is typically measured using sequence analysis software (for example, Sequence Analysis Software Package of the Genetics Computer Group, University of Wisconsin Biotechnology Center, 1710 University Avenue, Madison, Wis. 53705, BLAST, BESTFIT, GAP, or PILEUP/PRETTYBOX programs). Such software matches identical or similar sequences by assigning degrees of homology to various substitutions, deletions, and/or other modifications. Conservative substitutions typically include substitutions within the following groups: glycine, alanine; valine, isoleucine, leucine; aspartic acid, glutamic acid, asparagine, glutamine; serine, threonine; lysine, arginine; and phenylalanine, tyrosine. In an exemplary approach to determining the degree of identity, a BLAST program may be used, with a probability score between e⁻³ and e⁻¹⁰⁰ indicating a closely related sequence.

By “siRNA” is meant a double stranded RNA. Optimally, an siRNA is 18, 19, 20, 21, 22, 23 or 24 nucleotides in length and has a 2 base overhang at its 3′ end. These dsRNAs can be introduced to an individual cell or to a whole animal; for example, they may be introduced systemically via the bloodstream. Such siRNAs are used to downregulate mRNA levels or promoter activity.

By “specifically binds” is meant a compound or antibody that recognizes and binds a polypeptide of the invention, but which does not substantially recognize and bind other molecules in a sample, for example, a biological sample, which naturally includes a polypeptide of the invention.

By “subject” is meant a mammal, including, but not limited to, a human or non-human mammal, such as a bovine, equine, canine, ovine, or feline.

By “transgene” is meant any piece of DNA which is inserted by artifice into a cell, and becomes part of the genome of the organism which develops from that cell. Such a transgene may include a gene which is partly or entirely heterologous (i.e., foreign) to the transgenic organism, or may represent a gene homologous to an endogenous gene of the organism.

By “transgenic” is meant any cell which includes a DNA sequence which is inserted by artifice into a cell and becomes part of the genome of the organism which develops from that cell. As used herein, the transgenic organisms are generally transgenic mammalian (e.g., rodents such as rats or mice) and the DNA (transgene) is inserted by artifice into the nuclear genome.

By “transformation” is meant any method for introducing foreign molecules into a cell. Lipofection, calcium phosphate precipitation, retroviral deliver, electroporation and biolistic transformation are just a few of the teachings which may be used. For example, Biolistic transformation is a method for introducing foreign molecules into a cell using velocity driven microprojectiles such as tungsten or gold particles. Such velocity-driven methods originate from pressure bursts which include, but are not limited to, helium-driven, air-driven, and gunpowder-driven techniques. Biolistic transformation may be applied to the transformation or transfection of a wide variety of cell types and intact tissues including, without limitation, intracellular organdies (e.g., and mitochondria and chloroplasts), bacteria, yeast, fungi, algae, animal tissue, and cultured cells.

By “positioned for expression” is meant that the DNA molecule is positioned adjacent to a DNA sequence which directs transcription and translation of the sequence (i.e., facilitates the production of, e.g., an IAP polypeptide, a recombinant protein or a RNA molecule).

By “promoter” is meant minimal sequence sufficient to direct transcription. Also included in the invention are those promoter elements which are sufficient to render promoter-dependent gene expression controllable for cell-type specific, tissue-specific or inducible by external signals or agents; such elements may be located in the 5′ or 3′ regions of the native gene.

By “operably linked” is meant that a gene and a regulatory sequence(s) are connected in such a way as to permit gene expression when the appropriate molecules (e.g., transcriptional activator proteins) are bound to the regulatory sequence(s).

Ranges provided herein are understood to be shorthand for all of the values within the range. For example, a range of 1 to 50 is understood to include any number, combination of numbers, or sub-range from the group consisting 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, or 50.

As used herein, the terms “treat,” treating,” “treatment,” and the like refer to reducing or ameliorating a disorder and/or symptoms associated therewith. It will be appreciated that, although not precluded, treating a disorder or condition does not require that the disorder, condition or symptoms associated therewith be completely eliminated.

Unless specifically stated or obvious from context, as used herein, the term “or” is understood to be inclusive. Unless specifically stated or obvious from context, as used herein, the terms “a”, “an”, and “the” are understood to be singular or plural.

Unless specifically stated or obvious from context, as used herein, the term “about” is understood as within a range of normal tolerance in the art, for example within 2 standard deviations of the mean. About can be understood as within 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%, 0.1%, 0.05%, or 0.01% of the stated value. Unless otherwise clear from context, all numerical values provided herein are modified by the term about.

The recitation of a listing of chemical groups in any definition of a variable herein includes definitions of that variable as any single group or combination of listed groups. The recitation of an embodiment for a variable or aspect herein includes that embodiment as any single embodiment or in combination with any other embodiments or portions thereof.

Any compositions or methods provided herein can be combined with one or more of any of the other compositions and methods provided herein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-1D provide a proteomic analysis of lenalidomide-induced changes in ubiquitination, protein abundance and CRBN interaction in MM1S cells. FIG. 1A is a schematic diagram showing the experimental design for SILAC-based assessment of global changes in ubiquitination and protein levels. Cells were treated for 12 hours with DMSO, lenalidomide, or thalidomide. For ubiquitination analysis 5 μM MG132 were added for the last 3 hours. FIG. 1B is a ubiquitin analysis. Log₂ ratios for individual K-ε-GG sites of lenalidomide versus DMSO treated cells for replicate 1 and 2. Each dot represents a unique K-ε-GG site. FIG. 1C shows a proteome analysis. Log₂ ratios of changes of protein abundance of lenalidomide versus DMSO treated cells. Each dot represents a distinct protein group. FIG. 1D shows a CRBN interaction analysis in cells treated for 6 hours with 1 μM lenalidomide. Scatter plot shows log₂ changes of proteins pulled down by HA-CBRN in lenalidomide versus DMSO treated control cells.

FIGS. 2A-2C are provided. FIG. 2A shows the synthesis of a lenalidomide derivative immobilized to a bead that was used to pull down proteins binding lenalidomide FIG. 28 provides two graphs showing the viability (CellTiter-Glo® Luminescent Cell Viability Assay, Promega) of lenalidomide sensitive MM1S cells and lenalidomide insensitive K562 cells treated with lenalidomide or lenalidomide derivative for 6 days. FIG. 2C shows a schematic overview of pull down of candidate protein binders to lenalidomide beads. K562 cells were cultured in light (R0K0) or heavy (R10K6) SILAC media for 14 days to allow for quantitative assessment of proteins binding the lenalidomide derivative bead by LC-MS/MS. In the second condition cell lysates were additionally incubated with soluble lenalidomide to compete off binding proteins. The ratio of proteins pulled down in the lenalidomide beads only versus lenalidomide beads with soluble lenalidomide represent proteins that specifically bind lenalidomide. For a biological replicate SILAC labeling for the two conditions was switched.

FIGS. 3A and 3B show the results of a proteomic assessment of thalidomide induced in vivo changes of global ubiquitination and proteome. FIG. 3A shows scatter plots for log₂ ratios for individual K-ε-GG sites of lenalidomide versus DMSO treated cells for replicate 1 and 2. Each dot represents an individual KeGG site. The table shows median log₂ ratios from all 3 replicates. FIG. 3B shows Log₂ ratios of changes of protein abundance in lenalidomide versus DMSO treated cells. Each dot represents an individual protein. The table shows median log₂ ratios from 2 replicates.

FIG. 4 provides schematic diagrams illustrating the experimental design for SILAC-based assessment of CRBN interaction analysis in MM1S cells. HA-CRBN of DMSO and lenalidomide treated cells was immunoprecipitated with anti-HA Sepharose conjugate beads. Lysates of FLAG-CRBN expressing cells served as a negative control to exclude non-specific binding to the antibody-sepharose conjugate.

FIGS. 5A and 5B show results of CRBN co-immunoprecipitation, continued from FIG. 1G. FIG. 5A shows Scatter plots with log₂ ratios for (HA-CRBN expressing) DMSO treated versus (FLAG-CRBN expressing) control cells (left) and lenalidomide versus DMSO treated cells (both expressing HA-CRBN) (right). FIG. 5B shows a list of top (co-)immunoprecipitated proteins from DMSO treated versus control, lenalidomide treated versus control and lenalidomide versus DMSO treated cells. For log₂ ratios of lenalidomide versus DMSO treated cells only proteins that bound to CRBN in presence of lenalidomide and/or DMSO with a log₂ ratio >0.5 in both replicates were considered.

FIGS. 6A-6F show the effect of lenalidomide on IKZF1 and IKZF3 protein levels. FIG. 6A is a graph. 293T cells transfected with vectors expressing the indicated cDNA fused to firefly luciferase and control renilla luciferase were treated with DMSO or 1 μM lenalidomide for 24 hours. Bars represent the firefly to renilla luciferase ratio, normalized to DMSO-treated cells. FIG. 6B is a Western blot showing the effects of lenalidomide on endogenous IKZF1 and IKZF3 in MM1S cells treated for 24 hours. FIG. 6C is a Western blot showing a time course of lenalidomide treatment in MM1S cells for IKZF1 and IKZF3 protein levels and FIG. 6D mRNA levels. FIG. 6E provides immunoblots. Primary multiple myeloma samples were treated for 6 hours and analyzed by immunoblot. FIG. 6F shows an in vivo ubiquitination analysis of HA-tagged IKZF1 and IKZF3 expressed in MM1S cells treated for 1.5 hours with 100 nM Epoxomicin and the indicated concentrations of lenalidomide. The FK2 antibody detects covalently linked ubiquitin.

FIGS. 7A and 7B show that Lenalidomide induced decrease of IKZF1 and IKZF3 in different cell lines. Cells were treated in the presence of the respective lenalidomide concentrations for 24 hours. MM1S cells were treated with DMSO or 1 μM lenalidomide in the presence of 100 μg/ml Cycloheximide.

FIGS. 8A-8C show the in vivo ubiquitination of IKZF1 and IKZF3. Cells were treated with the indicated concentrations of lenalidomide and/or 100 nM epoxomicin for 1.5 hours. FIG. 8A shows results in 293T cells expressing stably transduced with a retrovirus expressing FLAG-IKZF3. FIG. 8B shows results in MM1S cells stably expressing HA-IKZF1. FIG. 8C shows endogenous IKZF3 of MM1S cells was immunoprecipitated by an polyclonal IKZF3 antibody.

FIGS. 9A-9D show that CRBN is a substrate receptor for IKZF1 and IKZF3. FIG. 9A is a Western blot showing the immunoprecipitation of endogenous CRBN in MM1S cells treated for 1 hour with the indicated drugs. FIG. 9B is shows the results of an in vitro ubiquitination reaction of HA-IKZF3 co-immunoprecipitated by FLAG-CRBN from 293T cells and incubated in the presence or absence of E1 and E2 ubiquitin conjugating enzymes. FIG. 9C is a schematic diagram showing the mapping of the degron that confers lenalidomide sensitivity. Blue boxes in the IKZF3 protein represent zinc finger domains. FIG. 9D shows a sequence alignment of the core lenalidomide degron between the 5 Ikaros proteins. Western blots of 293T cells lysates 48 hours after co-transfection of FLAG-tagged IKZF3 or IKZF4 with HA-tagged CRBN and 24 hours drug treatment.

FIG. 10 is a graph showing rescue of lenalidomide induced growth inhibition by expression of CRBN^(YWAA) that does not bind lenalidomide. NCI-H929 cells were transduced with a retroviral vector expressing CRBN wildtype and GFP or CRBN^(YWAA) and dTomato. Two days after transduction cells were mixed and treated with the indicated concentrations of lenalidomide. The ratio of dTomato versus GFP expressing cells was assessed by flow cytometry.

FIG. 11A-11C shows deletion mapping of IKZF3. FIG. 11A provides a representation of all IKZF3 mutants tested. Response to lenalidomide was assessed with an ORF-luciferase reporter. The red box indicates the critical peptide sequence (amino acids 140 to 180 of IKZF3) necessary for lenalidomide sensitivity. Substitution in the H177P/L178F mutant is based on the sequence alignment of IKZF1 and IKZF3 versus IKZF2 and IKZF4 and does not affect lenalidomide sensitivity in contrast to the Q147H substitution in IKZF3. FIG. 11B shows validation of lenalidomide response by western blot for several IKZF3 mutants. FLAG-tagged versions were cloned into the RSF91 vector, transfected into 293T cells together with a plasmid expressing HA-CRBN. After 24 hours media was replaced with media containing lenalidomide in the indicated concentrations and incubated another 24 hours before lysis. FIG. 11C shows the co-immunoprecipitation of FLAG-IKZF3 and its mutants by HA-CRBN. 293T cells were transfected with the indicated plasmids. After 48 hours 1 μM lenalidomide was added for 1 hour before lysis and HA-immunoprecipitation.

FIGS. 12A-12F shows the biological role of IKZF1 and IKZF3 in multiple myeloma cell lines and T cells. FIG. 12A includes two graphs showing that Lenalidomide-sensitive and insensitive cell lines were infected with lentivirus expressing IKZF1 or IKZF3 specific shRNAs and GFP. Relative depletion was assessed by flow cytometry and normalized to day 2 post infection. FIG. 12B is a graph showing that MM1S cells were transduced with retrovirus expressing GFP and wild-type IKZF3 or a dominant negative IKZF3 Isoform with deletion of the complete DNA binding region. FIG. 12C includes two graphs showing that MM1S cells were infected with different retrovirus and competed against each other in media containing DMSO or lenalidomide. Left panel: IKZF3^(wt)/GFP versus empty vector/dTomato. Right panel: IKZF3^(Q150H/)GFP versus IKZF3^(wt)/dTomato. FIG. 12D shows results from human CD3+ T cells isolated from buffy coats of healthy blood donors were stimulated with plate-bound anti-CD3 and anti-CD28 and treated with different concentrations of lenalidomide for 24 hours. FIG. 12E is a graph. T cells were infected with lentiviral vectors expressing shRNAs targeting the indicated genes. After selection with puromycin, T cells were stimulated with anti-CD3/CD28 Dynabeads and treated with DMSO or 1 μM lenalidomide for 12 hours before lysis. IL-2 RNA expression levels were analyzed by quantitative RT-PCR using GAPDH expression as an internal control. FIG. 12F is a graph. IL2 expression was measured in lenalidomide treated T cells expressing CRBN or control shRNAs.

FIG. 13 shows the Effect of a 2^(nd) shRNA for IKZF1 and IKZF3, respectively on cell growth of multiple myeloma and lenalidomide-insensitive cell lines. Same experimental setup as in FIG. 4A.

FIGS. 14A-14E show that lenalidomide and IKZF3 depletion result in decreased expression of IRF4 in MM1S cells. In FIG. 14A MM1S cells were treated for up to 48 hours with lenalidomide and IRF4 protein levels determined by immunoblot. FIG. 14B shows IRF4, IKZF1 and IKZF3 protein changes after 12 hours of lenalidomide treatment assessed by quantitative MS. FIG. 14C is a graph showing results of an RQ-PCR analysis of IRF4 RNA levels after 24 and 48 hour treatment with 1 μM lenalidomide. FIG. 14D shows an IRF4 Immunoblot of MM1S cells that were transduced with lentivirus expressing luciferase or IKZF3-specific shRNAs. FIG. 14E is a graph showing IRF4 RNA expression levels after IKZF3 knockdown.

FIG. 15A-15C include graphs (left hand panel) and immunoblots (right hand panel). Knockdown of shRNAs was assessed by RQ-PCR and immunoblot in MM1S cells for (FIG. 15A) IKZF1, (FIG. 15B) IKZF3, and (FIG. 15C) CRBN.

FIG. 16 shows results of SILAC-based quantitative MS studies used to characterize changes in the ubiquitinome and proteome in the MM1S multiple myeloma cell line cultured in the presence of lenalidomide.

FIG. 17 shows that lenalidomide treatment results in a dose-dependent decrease in casein kinase 1A1 (CSNK1A) protein levels in lenalidomide sensitive multiple myeloma cells. No significant change is observed in RNA expression.

FIG. 18 shows that lenalidomide treatment did not alter casein kinase 1A1 (CSNK1A) protein levels in mice.

FIG. 19 shows that expression of human CRBN in murine cells was sufficient to confer lenalidomide sensitivity to CSNK1A1.

FIGS. 20A-20D show lenalidomide-induced changes in ubiquitination and protein levels in KG-1 cells. FIG. 20A shows the log₂ ratios for individual K-ε-GG sites of lenalidomide- (1 μM) versus DMSO-treated cells for replicates 1 and 2. Each dot represents a unique K-ε-GG site. FIG. 20B shows the log₂ ratios of changes of protein abundance of lenalidomide- (1 μM) versus DMSO-treated cells for replicates 1 and 2. Each dot represents a unique protein group. FIG. 20C shows the effects of lenalidomide on endogenous CSNK1A1 levels in KG-1 cells after 24-hour treatment. FIG. 20D shows a time course of lenalidomide treatment in KG-1 cells for CSNK1A1 mRNA levels.

FIGS. 21A-21F show lenalidomide induces degradation of CSNK1A1 by CRBN-CRL4. FIG. 21A shows CSNK1A1 protein levels in KG-1 cells treated with DMSO or 1 μM or 10 μM lenalidomide alone or with MG-132 or MLN4924 for 6 hours. FIG. 21B shows CRBN knockout 293T cells were generated using CRISPR/Cas9-mediated deletion. The effect of lenalidomide on CSNK1A1 protein was assessed in normal and CRBN knockout 293T cells. FIG. 21C shows immunoprecipitation of HA-CRBN in 293T cells treated for 4 hour with MG132 and DMSO or lenalidomide. FIG. 21D shows in vivo ubiquitination analysis of tagged CSNK1A1 transiently expressed in 293T cells with or without CRBN. Cells were treated for 4 hours with the indicated concentrations of lenalidomide. The K2 antibody was used to detect ubiquitination of immunoprecipitated HA-CSNK1A1. FIG. 21E shows CD34⁺ cells isolated from cord blood were transduced with either luciferase control specific shRNA or CSNK1A1-specific shRNA expressing GFP labeled lentivirus. After 48 hours cells were either treated with DMSO or 1 μM lenalidomide. FIG. 21F shows the number of GFP positive cells as assessed by flow cytometry.

FIGS. 22A-22E show lenalidomide effects on murine cells. FIG. 22A shows murine Baf3 cells or primary murine AML cells transformed with an MLL-AF9 expressing retrovirus were treated with lenalidomide for 24 hours in vitro. CSNK1A1 protein levels were assessed by immunoblot. FIG. 22B shows murine Baf3 cells were transduced with a retrovirus expressing murine CRBN (m), human CRBN (h), human CRBN with single amino acid substitutions based on corresponding residues in murine CRBN, or empty vector. After selection with puromycin cells were treated for 24 hours with DMSO (−) or 1 μM lenalidomide (+) and CSNK1A1 protein levels were assessed by immunoblot. FIG. 22C shows alignment of human and murine CRBN. Non-conserved amino acids are indicated by red bars. In the enlarged segment of the lenalidomide binding region the critical non-conserved amino acid determining response to IMiDs (human V387, murine I391) is indicated in red, the previously described human CBRN mutant that does not bind IMiDs (Y383A/W385A) is indicated in green. FIG. 22D shows murine Baf3 cells were transduced with retrovirus expressing murine CRBN, human CRBN, murine CRBN^(V3911), or empty vector. After selection with puromycin cells were treated for 24 hours with DMSO or lenalidomide and CSNK1A1 protein levels were assessed by immunoblot. FIG. 22E shows human 293T cells were transfected with a IKZF3-luciferase fusion protein together with a human or murine CRBN. Cells were treated with DMSO or 1 μM lenalidomide for 4 hours.

FIGS. 23A-23D show the evaluation of lenalidomide in murine CSNK1A1^(+/−) cells. FIG. 23A is an illustration showing the experimental setup for in vitro competition experiments. Primary hematopoietic progenitors (cKIT+) were isolated from the bone marrow of CSNK1A1^(+/−) MxCre⁺ or MxCre⁺ mice treated with poly I:C 4 weeks before. When applicable, excision of exon 3 of CSNK1A1 on one allele was confirmed by excision PCR. One day after harvest cells were transduced with a retrovirus expressing murine CRBN^(V3911) and GFP. 72 hours after infection cells were sorted, mixed with SJL cells and treated with DMSO or lenalidomide. FIG. 23B is a graph showing the effects of 1 μM and 10 μM lenalidomide on CSNK1A1^(+/−)MxCre⁺ or MxCre⁺ cells as analyzed by flow cytometry. FIG. 23C shows the quantitative RT-PCR analysis of p21 expression in CSNK1A1^(+/−)MxCre⁺ or MxCre⁺ cells treated with DMSO or lenalidomide. FIG. 23D is a graphs showing the effects of lenalidomide in p53^(+/−) and p53^(+/+) cells.

FIGS. 24A-24D show lenalidomide-induced changes in ubiquitination and protein levels. FIG. 24A shows the log₂ ratios for individual K-ε-GG sites of lenalidomide- (10 μM) versus DMSO-treated cells for replicates 1 and 2. Each dot represents a unique K-ε-GG site. FIG. 24B shows the log₂ ratios of changes of protein abundance of lenalidomide- (10 μM) versus DMSO-treated cells for replicates 1 and 2. Each dot represents a unique protein group. FIG. 24C shows log₂ ratios for different lysine residues in CK1α, IKZF1, and CRBN for 1 or 10 μM lenalidomide treated cells versus DMSO treated cells. FIG. 24D shows a list of significantly regulated K-ε-GG sites with 1 μM or 10 μM lenalidomide vs. DMSO. P-value is adjusted as described in the methods section.

FIGS. 25A-25C show the effect of lenalidomide in human cells. FIG. 25A shows a time course of effect of lenalidomide treatment on CK1α protein levels in KG-1 cells. FIG. 25B shows the half-life of CK1α was assessed in 293T cells treated with 100 μg/ml cycloheximide in the absence or presence of 1 μM lenalidomide. FIG. 25C shows an immunoblot confirming the loss of CRBN expression in 293T cells with the CRBN gene disrupted by CRISPR/Cas genome editing.

FIGS. 26A-26D show sensitivity of human cells to growth inhibition by lenalidomide. FIG. 26A shows 293T cells treated with different concentrations of lenalidomide for 24 hours. CK1α protein levels were detected by western blot. FIG. 26B shows CSNK1A1 mRNA expression levels as measured by RQ-PCR. FIG. 26C shows CK1α protein levels as detected hourly by western blot in cells treated with 1 μM lenalidomide. FIG. 26D shows MM1S and MOLM13 cells treated with different concentrations of lenalidomide for 24 hours and CSNK1A1 mRNA expression levels were measured by RQ-PCR and CK1α protein levels were detected by western blot.

FIGS. 27A-27C show the effects of lenalidomide on mouse cells. FIG. 27A shows CK1α protein levels in Ba/F3 cells transduced with empty vector, mouse CRBN or human CRBN and treated with lenalidomide. FIG. 27B shows dual luciferase IKZF3 degradation assay in 293T cells expressing different CRBN chimeras and mutants. FIG. 27C shows the amino acid sequence alignment of mouse and human CRBN.

DETAILED DESCRIPTION OF THE INVENTION

As described below, the present invention features compositions and methods for identifying a subject having a B cell neoplasia or myelodysplastic syndrome responsive to treatment with lenalidomide and lenalidomide-related compounds.

The invention is based, at least in part, on the discovery that lenalidomide causes selective ubiquitination and degradation of two lymphoid transcription factors, IKZF1 and IKZF3, by the CRBN-CRL4 ubiquitin ligase. IKZF1 and IKZF3 are essential transcription factors for terminal B cell differentiation. A single amino acid substitution of IKZF3 conferred resistance to lenalidomide-induced degradation and rescued lenalidomide-induced inhibition of cell growth. Similarly, it was found that lenalidomide-induced IL2 production in T cells is due to depletion of IKZF3. These findings reveal a novel mechanism of action for a therapeutic agent, alteration of the activity of an E3 ubiquitin ligase leading to selective degradation of specific targets.

In other aspects, the invention features the discovery that casein kinase 1A1 (CSNK1A1) is a target of lenalidomide in del(5q) myelodysplastic syndrome (MDS). Myelodysplastic syndrome (MDS) is a heterogeneous clonal haematopoietic stem cell disorder characterised by ineffective haematopoiesis and a high risk of progression to acute myeloid leukemia (AML). Lenalidomide is often used for the treatment of patients with MDS with 5q deletion cytogenetic abnormalities. However, analysis of lenalidomide activity has been hampered by the relative insensitivity of murine cells to lenalidomide and related compounds. Expression of human CRBN in murine cells was sufficient to confer lenalidomide sensitivity to CSNK1A1. Accordingly, the present invention provides murine cells and transgenic animals expressing human CRBN or mutant CRBN.

Selection of Therapies for the Treatment of B Cell Neoplasia

As reported in detail below, lenalidomide causes the selective ubiquitination and degradation of lymphoid transcription factors, IKZF1 and IKZF3. IKZF1 and IKZF3 are expressed by B cell neoplasias that are sensitive to treatment with lenalidomide or a related compound, such as thalidomide or palidomide.

Lenalidomide, pomalidomide, and thalidomide have been shown to have immunomodulatory activity in multiple myeloma. Thus, these compounds are termed IMiDs.

The invention provides methods for selecting IMiD therapy for a subject having a B cell neoplasia by detecting an increased level of biomarkers IKZF1 and/or IKZF3 in a biological sample of the subject relative to the level present in a reference. Methods for detecting IKZF1 and IKZF3 are known in the art and described herein at Example 2.

The CRBN-CRL4 ubiquitin ligase selectively ubiquinates IKZF1 and IKZF3, thereby targeting IKZF1 and IKZF3 for lenalidomide-induced degradation. In one embodiment, the invention provides methods for selecting a therapy for a subject having a B cell neoplasia by detecting the lenalidomide-induced ubiquitination of IKZF1 and/or IKZF3 polypeptides in a biological sample from the subject. In other embodiments, the method involves detecting a decrease in ubiquitination of lysine residues of IKZF1 and IKZF3 prior to addition of a proteasome inhibitor (e.g., MG132). Methods for detecting ubiquination are known in the art and described, for example, herein at Example 1.

In other embodiments, the invention provides methods for selecting lenalidomide as a therapy for a subject having a B cell neoplasia. The method involves detecting a reduction in the level of IKZF1 and/or IKZF3 polypeptides in response to lenalidomide in a biological sample obtained from a subject.

Over time, many patients treated with lenalidomide acquire resistance to the therapeutic effects of lenalidomide. The early identification of lenalidomide resistance is important to patient survival because it allows for the selection of alternate therapies. As reported herein below, the anti-proliferative effect of lenalidomide in B cell neoplasias is mediated by depletion of IKZF1 and IKZF3. Accordingly, the invention provides methods for identifying the presence of lenalidomide resistant B cells by detecting IKZF1 and/or IKZF3 polypeptides that are resistant to lenalidomide-induced degradation. In one embodiment, a lenalidomide resistant B cell neoplasia is identified by detection of mutant IKZF1 or IKZF3 proteins that are not degraded in response to lenalidomide treatment or that are not ubiquitinated in response to lenalidomide treatment.

Subjects identified as having a lenalidomide resistant B cell neoplasia are identified as in need of alternative treatment. Subjects identified as having a lenalidomide resistant myeloma, for example, are treated with Velcade, corticosteroids, or other anti-neoplastic therapy. For subjects identified as having lenalidomide resistant myelodysplastic syndrome are treated, for example, with azacitidine or decitabine.

Ubiquitination of IKZF1 and IKZF3 in response to lenalidomide requires binding to CRBN. Mutations that reduce or inhibit IKZF1 and IKZF3 binding to CRBN also render the B cell neoplasia resistant to lenalidomide. Accordingly the invention provides methods for detecting a reduction in IKZF1 and/or IKZF3 binding to CRBN. Methods for detecting CRBN binding to IKZF1 and/or IKZF3 are known in the art and described, for example, at Examples 2 and 3. B cell neoplasias having a reduction in IKZF1 and/or IKZF3 binding to CRBN are identified as resistant to lenalidomide.

In still other embodiments, a lenalidomide resistant B cell neoplasia is identified by detecting a mutation in an IKZF3 degron sequence, such as a mutation in any one or more of amino acids 141-180 or 160-180. In particular embodiments, the invention provides for the detection of a mutation at amino acid 147, 150, 161, or 162. In still other embodiments, the invention provides for the detection of is Q147H, Q150H, L161R, or L162R. Methods for detecting a mutation of the invention include immunoassay, direct sequencing, and probe hybridization to a polynucleotide encoding the mutant polypeptide.

Monitoring

Methods of monitoring the sensitivity of a B cell neoplasa to lenalidomide in a subject are useful in managing subject treatment. Provided are methods where alterations in a IKZF1 and/or IKZF3 polypeptide (e.g, sequence, level, post-transcriptional modification, biological activity) are analysed, such as before and again after subject management or treatment. In these cases, the methods are used to monitor the status of lenalidomide sensitivity (e.g., response to lenalidomide treatment, resistance to lenalidomide, amelioration of the disease or progression of the disease).

For example, IKZF1 and/or IKZF3 polypeptide biomarkers can be used to monitor a subject's response to certain treatments of B cell neoplasia. The level, biological activity, sequence, post-transcriptional modification, or sensitivity to lenalidomide induced degradation of a IKZF1 and/or IKZF3 polypeptide may be assayed before treatment, during treatment, or following the conclusion of a treatment regimen. In some embodiments, multiple assays (e.g., 2, 3, 4, 5) are made at one or more of those times to assay resistance to lenalidomide.

Diagnostic Methods

Alterations in IKZF1 and/or IKZF3 polypeptides (e.g, sequence, level, post-transcriptional modification, biological activity) are detected in a biological sample obtained from a patient that has or has a propensity to develop a B cell neoplasia. Such biological samples include, but are not limited to, peripheral blood, bone marrow, or lymphoid tissue obtained from the subject relative to the level of such biomarkers in a reference.

Alterations in the levels of IKZF1 and/or IKZF3 polypeptide biomarkers (or any other marker delineated herein) are detected using standard methods. In one embodiment, the level of IKZF1 or IKZF3 is detected using an antibody that specifically binds the polypeptide. Exemplary antibodies that specifically bind such polypeptides are known in the art and described herein. Such antibodies are useful for the diagnosis of a B cell neoplasia that is sensitive to treatment with lenalidomide. Methods for measuring an antibody-biomarker complex include, for example, detection of fluorescence, luminescence, chemiluminescence, absorbance, reflectance, transmittance, birefringence or refractive index. Optical methods include microscopy (both confocal and non-confocal), imaging methods and non-imaging methods. Methods for performing these assays are readily known in the art. Useful assays include, for example, an enzyme immune assay (EIA), such as enzyme-linked immunosorbent assay (ELISA), a radioimmune assay (RIA), a Western blot assay, or a slot blot assay. Other assays useful for detecting changes in IKZF1 or IKZF3 are immunohistochemistry and quantitative fluorescent microscopy. These methods are also described in, e.g., Methods in Cell Biology: Antibodies in Cell Biology, volume 37 (Asai, ed. 1993); Basic and Clinical Immunology (Stites & Ten, eds., 7th ed. 1991); and Harlow & Lane, supra. Immunoassays can be used to determine the quantity of marker in a sample, where an increase or decrease in the level of the biomarker polypeptide is diagnostic of a patient having a B cell neoplasia that is sensitive or resistant to treatment with lenalidomide.

In general, the measurement of a IKZF1 and/or IKZF3 polypeptide in a subject sample is compared with an amount present in a reference. A diagnostic amount distinguishes between a B cell neoplasia that is sensitive to treatment with lenalidomide and a B cell neoplasia that is resistant to treatment with lenalidomide. The skilled artisan appreciates that the particular diagnostic amount used can be adjusted to increase sensitivity or specificity of the diagnostic assay depending on the preference of the diagnostician. In general, any significant alteration (e.g., at least about 10%, 15%, 30%, 50%, 60%, 75%, 80%, or 90%) in the level of a biomarker polypeptide in the subject sample relative to a reference may be used to diagnose a B cell neoplasia that is sensitive or resistant to treatment with lenalidomide. In one embodiment, the reference is the level of biomarker polypeptide present in a corresponding control sample obtained from a patient that does not have a B cell neoplasia. In another embodiment, the reference is a baseline level of IKZF1 and/or IKZF3 markers present in a biologic sample derived from a patient prior to, during, or after treatment with lenalidomide. In yet another embodiment, the reference is a standardized curve. In another example, levels of IKZF1 or IKZF3 are measured relative to the level of other B cell markers or actin.

Clinical Indicators

The present invention provides methods for detecting alterations in an IKZF1 and/or IKZF3 polypeptide biomarker in a biological sample (e.g., peripheral blood, bone marrow) derived from a subject having a B cell neoplasia to determine whether the B cell neoplasia is sensitive to treatment with lenalidomide or whether it has acquired lenalidomide resistance. Alterations in IKZF1 and/or IKZF3 are useful individually, or in combination with other markers typically used in characterizing a B cell neoplasia.

B-cell neoplasms typically recapitulate the normal stages of B-cell differentiation, and can be classified according to their putative cell of origin. Accordingly, alterations in IKZF1 and IKZF3 may be assayed alone or in combination with the neoplasm's cytogenetic profile, genotype, and immunophenotype. B cell markers useful in the methods of the invention include, but are not limited to, characterization of CD5, CD10, CD19, CD20, CD22, CD23, FMC7, CD79a, CD40, CD38, and CD138.

Microarrays

The methods of the invention may also be used for microarray-based assays that provide for the high-throughput analysis of an IKZF1 and/or IKZF3 polypeptide or polynucleotide. The IKZF1 and/or IKZF3 polypeptides, polynucleotides, or capture molecules that specifically bind to IKZF1 and/or IKZF3 polypeptides of the invention are useful as hybridizable array elements. If desired, arrays of the invention include, for example, other markers useful in the differential diagnosis of a B cell neoplasia (e.g., CD5, CD10, CD19, CD20, CD22, CD23, FMC7, CD79a, CD40, and CD38). The array elements are organized in an ordered fashion such that each element is present at a specified location on the substrate. Useful substrate materials include membranes, composed of paper, nylon or other materials, filters, chips, glass slides, and other solid supports. The ordered arrangement of the array elements allows hybridization patterns and intensities to be interpreted as expression levels of particular genes or proteins. Methods for making nucleic acid microarrays are known to the skilled artisan and are described, for example, in U.S. Pat. No. 5,837,832, Lockhart, et al. (Nat. Biotech. 14:1675-1680, 1996), and Schena, et al. (Proc. Natl. Acad. Sci. 93:10614-10619, 1996), herein incorporated by reference. Methods for making polypeptide microarrays are described, for example, by Ge (Nucleic Acids Res. 28:e3.i-e3.vii, 2000), MacBeath et al., (Science 289:1760-1763, 2000), Zhu et al. (Nature Genet. 26:283-289), and in U.S. Pat. No. 6,436,665, hereby incorporated by reference.

IKZF1 and/or IKZF3 polypeptide may also be analyzed using protein microarrays. Typically, protein microarrays feature a protein, or fragment thereof, bound to a solid support. In particular embodiments, the proteins are antibodies that specifically bind a biomarker of the invention (e.g., IKZF1 and/or IKZF3 polypeptide). Suitable solid supports include membranes (e.g., membranes composed of nitrocellulose, paper, or other material), polymer-based films (e.g., polystyrene), beads, or glass slides. For some applications, biomarker polypeptides or antibodies recognizing such biomarkers are spotted on a substrate using any convenient method known to the skilled artisan (e.g., by hand or by inkjet printer).

Biomarker levels present in a biological sample taken from a patient, such as a bodily fluid (e.g., peripheral blood) may be measured using an antibody or other molecule derived from a peptide, nucleic acid, or chemical library. Hybridization conditions (e.g., temperature, pH, protein concentration, and ionic strength) are optimized to promote specific interactions. Such conditions are known to the skilled artisan and are described, for example, in Harlow, F. and Lane, D., Using Antibodies: A Laboratory Manual. 1998, New York: Cold Spring Harbor Laboratories. After removal of non-specific probes, specifically bound probes are detected, for example, by fluorescence, enzyme activity (e.g., an enzyme-linked calorimetric assay), direct immunoassay, radiometric assay, or any other suitable detectable method known to the skilled artisan.

Kits

In one aspect, the invention provides kits for monitoring lenalidomide sensitivity, including the development of lenalidomide resistance. For example, the kits can be used to detect an alteration in an IKZF1 and/or IKZF3 polypeptide (e.g, sequence, level, post-transcriptional modification, biological activity). If desired a kit includes any one or more of the following: capture molecules that bind IKZF1 and/or IKZF3. The kits have many applications. For example, the kits can be used to determine if a subject has a lenalidomide sensitive B cell neoplasia or if the subject has developed resistance to lenalidomide.

The kits may include instructions for the assay, reagents, testing equipment (test tubes, reaction vessels, needles, syringes, etc.), standards for calibrating the assay, and/or equipment provided or used to conduct the assay. The instructions provided in a kit according to the invention may be directed to suitable operational parameters in the form of a label or a separate insert.

Inhibitory Nucleic Acids

As reported herein below, the anti-proliferative effect of lenalidomide in B cell neoplasias is mediated by depletion of IKZF1 and/or IKZF3. Accordingly, the invention provides oligonucleotides that inhibit the expression of IKZF1 and/or IKZF3. Such inhibitory nucleic acid molecules include single and double stranded nucleic acid molecules (e.g., DNA, RNA, and analogs thereof) that bind a nucleic acid molecule that encodes an IKZF1 and/or IKZF3 polypeptide (e.g., antisense molecules, siRNA, shRNA).

siRNA

Short twenty-one to twenty-five nucleotide double-stranded RNAs are effective at down-regulating gene expression (Zamore et al., Cell 101: 25-33; Elbashir et al., Nature 411: 494-498, 2001, hereby incorporated by reference). The therapeutic effectiveness of an siRNA approach in mammals was demonstrated in vivo by McCaffrey et al. (Nature 418: 38-39.2002).

Given the sequence of a target gene, siRNAs may be designed to inactivate that gene. Such siRNAs, for example, could be administered directly to an affected tissue, or administered systemically. The nucleic acid sequence of a gene can be used to design small interfering RNAs (siRNAs). The 21 to 25 nucleotide siRNAs may be used, for example, as therapeutics to treat a B cell neoplasia.

The inhibitory nucleic acid molecules of the present invention may be employed as double-stranded RNAs for RNA interference (RNAi)-mediated knock-down of IKZF1 and/or IKZF3 expression. RNAi is a method for decreasing the cellular expression of specific proteins of interest (reviewed in Tuschl, Chembiochem 2:239-245, 2001; Sharp, Genes & Devel. 15:485-490, 2000; Hutvagner and Zamore, Curr. Opin. Genet. Devel. 12:225-232, 2002; and Hannon, Nature 418:244-251, 2002). The introduction of siRNAs into cells either by transfection of dsRNAs or through expression of siRNAs using a plasmid-based expression system is increasingly being used to create loss-of-function phenotypes in mammalian cells.

In one embodiment of the invention, a double-stranded RNA (dsRNA) molecule is made that includes between eight and nineteen consecutive nucleobases of a nucleobase oligomer of the invention. The dsRNA can be two distinct strands of RNA that have duplexed, or a single RNA strand that has self-duplexed (small hairpin (sh)RNA). Typically, dsRNAs are about 21 or 22 base pairs, but may be shorter or longer (up to about 29 nucleobases) if desired. dsRNA can be made using standard techniques (e.g., chemical synthesis or in vitro transcription). Kits are available, for example, from Ambion (Austin, Tex.) and Epicentre (Madison, Wis.). Methods for expressing dsRNA in mammalian cells are described in Brummelkamp et al. Science 296:550-553, 2002; Paddison et al. Genes & Devel. 16:948-958, 2002. Paul et al. Nature Biotechnol. 20:505-508, 2002; Sui et al. Proc. Natl. Acad. Sci. USA 99:5515-5520, 2002; Yu et al. Proc. Natl. Acad. Sci. USA 99:6047-6052, 2002; Miyagishi et al. Nature Biotechnol. 20:497-500, 2002; and Lee et al. Nature Biotechnol. 20:500-505 2002, each of which is hereby incorporated by reference.

Small hairpin RNAs (shRNAs) comprise an RNA sequence having a stem-loop structure. A “stem-loop structure” refers to a nucleic acid having a secondary structure that includes a region of nucleotides which are known or predicted to form a double strand or duplex (stem portion) that is linked on one side by a region of predominantly single-stranded nucleotides (loop portion). The teen “hairpin” is also used herein to refer to stem-loop structures. Such structures are well known in the art and the term is used consistently with its known meaning in the art. As is known in the art, the secondary structure does not require exact base-pairing. Thus, the stem can include one or more base mismatches or bulges. Alternatively, the base-pairing can be exact, i.e. not include any mismatches. The multiple stem-loop structures can be linked to one another through a linker, such as, for example, a nucleic acid linker, a miRNA flanking sequence, other molecule, or some combination thereof.

As used herein, the term “small hairpin RNA” includes a conventional stem-loop shRNA, which forms a precursor miRNA (pre-miRNA). While there may be some variation in range, a conventional stem-loop shRNA can comprise a stem ranging from 19 to 29 bp, and a loop ranging from 4 to 30 bp. “shRNA” also includes micro-RNA embedded shRNAs (miRNA-based shRNAs), wherein the guide strand and the passenger strand of the miRNA duplex are incorporated into an existing (or natural) miRNA or into a modified or synthetic (designed) miRNA. In some instances the precursor miRNA molecule can include more than one stem-loop structure. MicroRNAs are endogenously encoded RNA molecules that are about 22-nucleotides long and generally expressed in a highly tissue- or developmental-stage-specific fashion and that post-transcriptionally regulate target genes. More than 200 distinct miRNAs have been identified in plants and animals. These small regulatory RNAs are believed to serve important biological functions by two prevailing modes of action: (1) by repressing the translation of target mRNAs, and (2) through RNA interference (RNAi), that is, cleavage and degradation of mRNAs. In the latter case, miRNAs function analogously to small interfering RNAs (siRNAs). Thus, one can design and express artificial miRNAs based on the features of existing miRNA genes.

shRNAs can be expressed from DNA vectors to provide sustained silencing and high yield delivery into almost any cell type. In some embodiments, the vector is a viral vector. Exemplary viral vectors include retroviral, including lentiviral, adenoviral, baculoviral and avian viral vectors, and including such vectors allowing for stable, single-copy genomic integrations. Retroviruses from which the retroviral plasmid vectors can be derived include, but are not limited to, Moloney Murine Leukemia Virus, spleen necrosis virus, Rous sarcoma Virus, Harvey Sarcoma Virus, avian leukosis virus, gibbon ape leukemia virus, human immunodeficiency virus, Myeloproliferative Sarcoma Virus, and mammary tumor virus. A retroviral plasmid vector can be employed to transduce packaging cell lines to form producer cell lines. Examples of packaging cells which can be transfected include, but are not limited to, the PE501, PA317, R-2, R-AM, PA12, T19-14x, VT-19-17-H2, RCRE, RCRIP, GP+E-86, GP+envAm12, and DAN cell lines as described in Miller, Human Gene Therapy 1:5-14 (1990), which is incorporated herein by reference in its entirety. The vector can transduce the packaging cells through any means known in the art. A producer cell line generates infectious retroviral vector particles which include polynucleotide encoding a DNA replication protein. Such retroviral vector particles then can be employed, to transduce eukaryotic cells, either in vitro or in vivo. The transduced eukaryotic cells will express a DNA replication protein.

Catalytic RNA molecules or ribozymes that include an antisense sequence of the present invention can be used to inhibit expression of a IKZF1 and/or IKZF3 nucleic acid molecule in vivo. The inclusion of ribozyme sequences within antisense RNAs confers RNA-cleaving activity upon them, thereby increasing the activity of the constructs. The design and use of target RNA-specific ribozymes is described in Haseloff et al., Nature 334:585-591. 1988, and U.S. Patent Application Publication No. 2003/0003469 A1, each of which is incorporated by reference.

Accordingly, the invention also features a catalytic RNA molecule that includes, in the binding arm, an antisense RNA having between eight and nineteen consecutive nucleobases. In preferred embodiments of this invention, the catalytic nucleic acid molecule is formed in a hammerhead or hairpin motif. Examples of such hammerhead motifs are described by Rossi et al., Aids Research and Human Retroviruses, 8:183, 1992. Example of hairpin motifs are described by Hampel et al., “RNA Catalyst for Cleaving Specific RNA Sequences,” filed Sep. 20, 1989, which is a continuation-in-part of U.S. Ser. No. 07/247,100 filed Sep. 20, 1988, Hampel and Tritz, Biochemistry, 28:4929, 1989, and Hampel et al., Nucleic Acids Research, 18: 299, 1990. These specific motifs are not limiting in the invention and those skilled in the art will recognize that all that is important in an enzymatic nucleic acid molecule of this invention is that it has a specific substrate binding site which is complementary to one or more of the target gene RNA regions, and that it have nucleotide sequences within or surrounding that substrate binding site which impart an RNA cleaving activity to the molecule.

Essentially any method for introducing a nucleic acid construct into cells can be employed. Physical methods of introducing nucleic acids include injection of a solution containing the construct, bombardment by particles covered by the construct, soaking a cell, tissue sample or organism in a solution of the nucleic acid, or electroporation of cell membranes in the presence of the construct. A viral construct packaged into a viral particle can be used to accomplish both efficient introduction of an expression construct into the cell and transcription of the encoded shRNA. Other methods known in the art for introducing nucleic acids to cells can be used, such as lipid-mediated carrier transport, chemical mediated transport, such as calcium phosphate, and the like. Thus the shRNA-encoding nucleic acid construct can be introduced along with components that perform one or more of the following activities: enhance RNA uptake by the cell, promote annealing of the duplex strands, stabilize the annealed strands, or otherwise increase inhibition of the target gene.

For expression within cells, DNA vectors, for example plasmid vectors comprising either an RNA polymerase H or RNA polymerase III promoter can be employed. Expression of endogenous miRNAs is controlled by RNA polymerase II (Pol II) promoters and in some cases, shRNAs are most efficiently driven by Pol II promoters, as compared to RNA polymerase III promoters (Dickins et al., 2005, Nat. Genet. 39: 914-921). In some embodiments, expression of the shRNA can be controlled by an inducible promoter or a conditional expression system, including, without limitation, RNA polymerase type II promoters. Examples of useful promoters in the context of the invention are tetracycline-inducible promoters (including TRE-tight), IPTG-inducible promoters, tetracycline transactivator systems, and reverse tetracycline transactivator (rtTA) systems. Constitutive promoters can also be used, as can cell- or tissue-specific promoters. Many promoters will be ubiquitous, such that they are expressed in all cell and tissue types. A certain embodiment uses tetracycline-responsive promoters, one of the most effective conditional gene expression systems in in vitro and in vivo studies. See International Patent Application PCT/US2003/030901 (Publication No. WO 2004-029219 A2) and Fewell et al., 2006, Drug Discovery Today 11: 975-982, for a description of inducible shRNA.

Delivery of Polynucleotides

Naked polynucleotides, or analogs thereof, are capable of entering mammalian cells and inhibiting expression of a gene of interest. Nonetheless, it may be desirable to utilize a formulation that aids in the delivery of oligonucleotides or other nucleobase oligomers to cells (see, e.g., U.S. Pat. Nos. 5,656,611, 5,753,613, 5,785,992, 6,120,798, 6,221,959, 6,346,613, and 6,353,055, each of which is hereby incorporated by reference).

Therapy

Therapy may be provided at home, the doctor's office, a clinic, a hospital's outpatient department, or a hospital. Treatment generally begins at a hospital so that the doctor can observe the therapy's effects closely and make any adjustments that are needed. The duration of the therapy depends on the kind of cancer being treated, the age and condition of the patient, the stage and type of the patient's disease, and how the patient's body responds to the treatment. Drug administration may be performed at different intervals (e.g., daily, weekly, or monthly).

Oligonucleotides and Other Nucleobase Oligomers

At least two types of oligonucleotides induce the cleavage of RNA by RNase H: polydeoxynucleotides with phosphodiester (PO) or phosphorothioate (PS) linkages. Although 2′-OMe-RNA sequences exhibit a high affinity for RNA targets, these sequences are not substrates for RNase H. A desirable oligonucleotide is one based on 2′-modified oligonucleotides containing oligodeoxynucleotide gaps with some or all internucleotide linkages modified to phosphorothioates for nuclease resistance. The presence of methylphosphonate modifications increases the affinity of the oligonucleotide for its target RNA and thus reduces the IC₅₀. This modification also increases the nuclease resistance of the modified oligonucleotide. It is understood that the methods and reagents of the present invention may be used in conjunction with any technologies that may be developed, including covalently-closed multiple antisense (CMAS) oligonucleotides (Moon et al., Biochem J. 346:295-303, 2000; PCT Publication No. WO 00/61595), ribbon-type antisense (RiAS) oligonucleotides (Moon et al., J. Biol. Chem. 275:4647-4653, 2000; PCT Publication No. WO 00/61595), and large circular antisense oligonucleotides (U.S. Patent Application Publication No. US 2002/0168631 A1).

As is known in the art, a nucleoside is a nucleobase-sugar combination. The base portion of the nucleoside is normally a heterocyclic base. The two most common classes of such heterocyclic bases are the purines and the pyrimidines. Nucleotides are nucleosides that further include a phosphate group covalently linked to the sugar portion of the nucleoside. For those nucleosides that include a pentofuranosyl sugar, the phosphate group can be linked to either the 2′, 3′ or 5′ hydroxyl moiety of the sugar. In forming oligonucleotides, the phosphate groups covalently link adjacent nucleosides to one another to form a linear polymeric compound. In turn, the respective ends of this linear polymeric structure can be further joined to form a circular structure; open linear structures are generally preferred. Within the oligonucleotide structure, the phosphate groups are commonly referred to as forming the backbone of the oligonucleotide. The normal linkage or backbone of RNA and DNA is a 3′ to 5′ phosphodiester linkage.

Specific examples of preferred nucleobase oligomers useful in this invention include oligonucleotides containing modified backbones or non-natural internucleoside linkages. As defined in this specification, nucleobase oligomers having modified backbones include those that retain a phosphorus atom in the backbone and those that do not have a phosphorus atom in the backbone. For the purposes of this specification, modified oligonucleotides that do not have a phosphorus atom in their internucleoside backbone are also considered to be nucleobase oligomers.

Nucleobase oligomers that have modified oligonucleotide backbones include, for example, phosphorothioates, chiral phosphorothioates, phosphorodithioates, phosphotriesters, aminoalkyl-phosphotriesters, methyl and other alkyl phosphonates including 3′-alkylene phosphonates and chiral phosphonates, phosphinates, phosphoramidates including 3′-amino phosphoramidate and aminoalkylphosphoramidates, thionophosphoramidates, thionoalkylphosphonates, thionoalkylphosphotriest-ers, and boranophosphates having normal 3′-5′ linkages, 2′-5′ linked analogs of these, and those having inverted polarity, wherein the adjacent pairs of nucleoside units are linked 3′-5′ to 5′-3′ or 2′-5′ to 5′-2′. Various salts, mixed salts and free acid forms are also included. Representative United States patents that teach the preparation of the above phosphorus-containing linkages include, but are not limited to, U.S. Pat. Nos. 3,687,808; 4,469,863; 4,476,301; 5,023,243; 5,177,196; 5,188,897; 5,264,423; 5,276,019; 5,278,302; 5,286,717; 5,321,131; 5,399,676; 5,405,939; 5,453,496; 5,455,233; 5,466,677; 5,476,925; 5,519,126; 5,536,821; 5,541,306; 5,550,111; 5,563,253; 5,571,799; 5,587,361; and 5,625,050, each of which is herein incorporated by reference.

Nucleobase oligomers having modified oligonucleotide backbones that do not include a phosphorus atom therein have backbones that are formed by short chain alkyl or cycloalkyl internucleoside linkages, mixed heteroatom and alkyl or cycloalkyl internucleoside linkages, or one or more short chain heteroatomic or heterocyclic internucleoside linkages. These include those having morpholino linkages (formed in part from the sugar portion of a nucleoside); siloxane backbones; sulfide, sulfoxide and sulfone backbones; formacetyl and thioformacetyl backbones; methylene formacetyl and thioformacetyl backbones; alkene containing backbones; sulfamate backbones; methyleneimino and methylenehydrazino backbones; sulfonate and sulfonamide backbones; amide backbones; and others having mixed N, O, S and CH.sub.2 component parts. Representative United States patents that teach the preparation of the above oligonucleotides include, but are not limited to, U.S. Pat. Nos. 5,034,506; 5,166,315; 5,185,444; 5,214,134; 5,216,141; 5,235,033; 5,264,562; 5,264,564; 5,405,938; 5,434,257; 5,466,677; 5,470,967; 5,489,677; 5,541,307; 5,561,225; 5,596,086; 5,602,240; 5,610,289; 5,602,240; 5,608,046; 5,610,289; 5,618,704; 5,623,070; 5,663,312; 5,633,360; 5,677,437; and 5,677,439, each of which is herein incorporated by reference.

In other nucleobase oligomers, both the sugar and the internucleoside linkage, i.e., the backbone, are replaced with novel groups. The nucleobase units are maintained for hybridization with a gene listed in Table 2 or 3. One such nucleobase oligomer, is referred to as a Peptide Nucleic Acid (PNA). In PNA compounds, the sugar-backbone of an oligonucleotide is replaced with an amide containing backbone, in particular an aminoethylglycine backbone. The nucleobases are retained and are bound directly or indirectly to aza nitrogen atoms of the amide portion of the backbone. Methods for making and using these nucleobase oligomers are described, for example, in “Peptide Nucleic Acids: Protocols and Applications” Ed. P. E. Nielsen, Horizon Press, Norfolk, United Kingdom, 1999. Representative United States patents that teach the preparation of PNAs include, but are not limited to, U.S. Pat. Nos. 5,539,082; 5,714,331; and 5,719,262, each of which is herein incorporated by reference. Further teaching of PNA compounds can be found in Nielsen et al., Science, 1991, 254, 1497-1500.

In particular embodiments or the invention, the nucleobase oligomers have phosphorothioate backbones and nucleosides with heteroatom backbones, and in particular —CH₂—NH—O—CH₂—, —CH₂—N(CH₃)—O—CH₂— (known as a methylene (methylimino) or MMI backbone), —CH₂—O—N(CH₃)—CH₂—, —CH₂—N(CH₃)—N(CH₃)—CH₂—, and —O—N(CH₃)—CH₂—CH₂—. In other embodiments, the oligonucleotides have morpholino backbone structures described in U.S. Pat. No. 5,034,506.

Nucleobase oligomers may also contain one or more substituted sugar moieties. Nucleobase oligomers comprise one of the following at the 2′ position: OH; F; O-, S-, or N-alkyl; O-, S-, or N-alkenyl; O-, S- or N-alkynyl; or O-alkyl-O-alkyl, wherein the alkyl, alkenyl, and alkynyl may be substituted or unsubstituted C₁ to C₁₀ alkyl or C₂ to C₁₀ alkenyl and alkynyl. Particularly preferred are O[(CH₂)_(n)O]_(n)CH₃, O(CH₂)_(n)OCH₃, O(CH₂)_(n)NH₂, O(CH₂)_(n)CH₃, O(CH₂)_(n)ONH₂, and O(CH₂)nON[(CH₂)_(n)CH₃)]₂, where n and m are from 1 to about 10. Other preferred nucleobase oligomers include one of the following at the 2′ position: C₁ to C₁₀ lower alkyl, substituted lower alkyl, alkaryl, aralkyl, O-alkaryl, or O-aralkyl, SH, SCH₃, OCN, Cl, Br, CN, CF₃, OCF₃, SOCH₃, SO₂CH₃, ONO₂, NO₂, NH₂, heterocycloalkyl, heterocycloalkaryl, aminoalkylamino, polyalkylamino, substituted silyl, an RNA cleaving group, a reporter group, an intercalator, a group for improving the pharmacokinetic properties of a nucleobase oligomer, or a group for improving the pharmacodynamic properties of an nucleobase oligomer, and other substituents having similar properties. Preferred modifications are 2′-O-methyl and 2′-methoxyethoxy (2′-O—CH₂CH₂OCH₃, also known as 2′-O-(2-methoxyethyl) or 2′-MOE). Another desirable modification is 2′-dimethylaminooxyethoxy (i.e., O(CH₂)₂ON(CH₃)₂), also known as 2′-DMAOE. Other modifications include, 2′-aminopropoxy (2′-OCH₂CH₂CH₂NH₂) and 2′-fluoro (2′-F). Similar modifications may also be made at other positions on an oligonucleotide or other nucleobase oligomer, particularly the 3′ position of the sugar on the 3′ terminal nucleotide or in 2′-5′ linked oligonucleotides and the 5′ position of 5′ terminal nucleotide. Nucleobase oligomers may also have sugar mimetics such as cyclobutyl moieties in place of the pentofuranosyl sugar. Representative United States patents that teach the preparation of such modified sugar structures include, but are not limited to, U.S. Pat. Nos. 4,981,957; 5,118,800; 5,319,080; 5,359,044; 5,393,878; 5,446,137; 5,466,786; 5,514,785; 5,519,134; 5,567,811; 5,576,427; 5,591,722; 5,597,909; 5,610,300; 5,627,053; 5,639,873; 5,646,265; 5,658,873; 5,670,633; and 5,700,920, each of which is herein incorporated by reference in its entirety.

Nucleobase oligomers may also include nucleobase modifications or substitutions. As used herein, “unmodified” or “natural” nucleobases include the purine bases adenine (A) and guanine (G), and the pyrimidine bases thymine (T), cytosine (C) and uracil (U). Modified nucleobases include other synthetic and natural nucleobases, such as 5-methylcytosine (5-me-C), 5-hydroxymethyl cytosine, xanthine, hypoxanthine, 2-aminoadenine, 6-methyl and other alkyl derivatives of adenine and guanine; 2-propyl and other alkyl derivatives of adenine and guanine; 2-thiouracil, 2-thiothymine and 2-thiocytosine; 5-halouracil and cytosine; 5-propynyl uracil and cytosine; 6-azo uracil, cytosine and thymine; 5-uracil (pseudouracil); 4-thiouracil; 8-halo, 8-amino, 8-thiol, 8-thioalkyl, 8-hydroxyl and other 8-substituted adenines and guanines; 5-halo (e.g., 5-bromo), 5-trifluoromethyl and other 5-substituted uracils and cytosines; 7-methylguanine and 7-methyladenine; 8-azaguanine and 8-azaadenine; 7-deazaguanine and 7-deazaadenine; and 3-deazaguanine and 3-deazaadenine. Further nucleobases include those disclosed in U.S. Pat. No. 3,687,808, those disclosed in The Concise Encyclopedia Of Polymer Science And Engineering, pages 858-859, Kroschwitz, J. I., ed. John Wiley & Sons, 1990, those disclosed by Englisch et al., Angewandte Chemie, International Edition, 1991, 30, 613, and those disclosed by Sanghvi, Y. S., Chapter 15, Antisense Research and Applications, pages 289-302, Crooke, S. T. and Lebleu, B., ed., CRC Press, 1993. Certain of these nucleobases are particularly useful for increasing the binding affinity of an antisense oligonucleotide of the invention. These include 5-substituted pyrimidines, 6-azapyrimidines, and N-2, N-6 and 0-6 substituted purines, including 2-aminopropyladenine, 5-propynyluracil and 5-propynylcytosine. 5-methylcytosine substitutions have been shown to increase nucleic acid duplex stability by 0.6-1.2.degree.C. (Sanghvi, Y. S., Crooke, S. T. and Lebleu, B., eds., Antisense Research and Applications, CRC Press, Boca Raton, 1993, pp. 276-278) and are desirable base substitutions, even more particularly when combined with 2′-O-methoxyethyl or 2′-O-methyl sugar modifications. Representative United States patents that teach the preparation of certain of the above noted modified nucleobases as well as other modified nucleobases include U.S. Pat. Nos. 4,845,205; 5,130,302; 5,134,066; 5,175,273; 5,367,066; 5,432,272; 5,457,187; 5,459,255; 5,484,908; 5,502,177; 5,525,711; 5,552,540; 5,587,469; 5,594,121, 5,596,091; 5,614,617; 5,681,941; and 5,750,692, each of which is herein incorporated by reference.

Another modification of a nucleobase oligomer of the invention involves chemically linking to the nucleobase oligomer one or more moieties or conjugates that enhance the activity, cellular distribution, or cellular uptake of the oligonucleotide. Such moieties include but are not limited to lipid moieties such as a cholesterol moiety (Letsinger et al., Proc. Natl. Acad. Sci. USA, 86:6553-6556, 1989), cholic acid (Manoharan et al., Bioorg. Med. Chem. Let, 4:1053-1060, 1994), a thioether, e.g., hexyl-S-tritylthiol (Manoharan et al., Ann. N.Y. Acad. Sci., 660:306-309, 1992; Manoharan et al., Bioorg. Med. Chem. Let., 3:2765-2770, 1993), a thiocholesterol (Oberhauser et al., Nucl. Acids Res., 20:533-538: 1992), an aliphatic chain, e.g., dodecandiol or undecyl residues (Saison-Behmoaras et al., EMBO J., 10:1111-1118, 1991; Kabanov et al., FEBS Lett., 259:327-330, 1990; Svinarchuk et al., Biochimie, 75:49-54, 1993), a phospholipid, e.g., di-hexadecyl-rac-glycerol or triethylammonium 1,2-di-O-hexadecyl-rac-glycero-3-H-phosphonate (Manoharan et al., Tetrahedron Lett., 36:3651-3654, 1995; Shea et al., Nucl. Acids Res., 18:3777-3783, 1990), a polyamine or a polyethylene glycol chain (Manoharan et al., Nucleosides & Nucleotides, 14:969-973, 1995), or adamantane acetic acid (Manoharan et al., Tetrahedron Lett., 36:3651-3654, 1995), a palmityl moiety (Mishra et al., Biochim. Biophys. Acta, 1264:229-237, 1995), or an octadecylamine or hexylamino-carbonyl-oxycholesterol moiety (Crooke et al., J. Pharmacol. Exp. Ther., 277:923-937, 1996. Representative United States patents that teach the preparation of such nucleobase oligomer conjugates include U.S. Pat. Nos. 4,587,044; 4,605,735; 4,667,025; 4,762,779; 4,789,737; 4,824,941; 4,828,979; 4,835,263; 4,876,335; 4,904,582; 4,948,882; 4,958,013; 5,082,830; 5,109,124; 5,112,963; 5,118,802; 5,138,045; 5,214,136; 5,218,105; 5,245,022; 5,254,469; 5,258,506; 5,262,536; 5,272,250; 5,292,873; 5,317,098; 5,371,241, 5,391,723; 5,414,077; 5,416,203, 5,451,463; 5,486,603; 5,510,475; 5,512,439; 5,512,667; 5,514,785; 5,525,465; 5,541,313; 5,545,730; 5,552,538; 5,565,552; 5,567,810; 5,574,142; 5,578,717; 5,578,718; 5,580,731; 5,585,481; 5,587,371; 5,591,584; 5,595,726; 5,597,696; 5,599,923; 5,599,928; 5,608,046: and 5,688,941, each of which is herein incorporated by reference.

The present invention also includes nucleobase oligomers that are chimeric compounds. “Chimeric” nucleobase oligomers are nucleobase oligomers, particularly oligonucleotides, that contain two or more chemically distinct regions, each made up of at least one monomer unit, i.e., a nucleotide in the case of an oligonucleotide. These nucleobase oligomers typically contain at least one region where the nucleobase oligomer is modified to confer, upon the nucleobase oligomer, increased resistance to nuclease degradation, increased cellular uptake, and/or increased binding affinity for the target nucleic acid. An additional region of the nucleobase oligomer may serve as a substrate for enzymes capable of cleaving RNA:DNA or RNA:RNA hybrids. By way of example, RNase H is a cellular endonuclease which cleaves the RNA strand of an RNA:DNA duplex. Activation of RNase H, therefore, results in cleavage of the RNA target, thereby greatly enhancing the efficiency of nucleobase oligomer inhibition of gene expression. Consequently, comparable results can often be obtained with shorter nucleobase oligomers when chimeric nucleobase oligomers are used, compared to phosphorothioate deoxyoligonucleotides hybridizing to the same target region.

Chimeric nucleobase oligomers of the invention may be formed as composite structures of two or more nucleobase oligomers as described above. Such nucleobase oligomers, when oligonucleotides, have also been referred to in the art as hybrids or gapmers. Representative United States patents that teach the preparation of such hybrid structures include U.S. Pat. Nos. 5,013,830; 5,149,797; 5,220,007; 5,256,775; 5,366,878; 5,403,711; 5,491,133; 5,565,350; 5,623,065; 5,652,355; 5,652,356; and 5,700,922, each of which is herein incorporated by reference in its entirety.

The nucleobase oligomers used in accordance with this invention may be conveniently and routinely made through the well-known technique of solid phase synthesis. Equipment for such synthesis is sold by several vendors including, for example, Applied Biosystems (Foster City, Calif.). Any other means for such synthesis known in the art may additionally or alternatively be employed. It is well known to use similar techniques to prepare oligonucleotides such as the phosphorothioates and alkylated derivatives.

The nucleobase oligomers of the invention may also be admixed, encapsulated, conjugated or otherwise associated with other molecules, molecule structures or mixtures of compounds, as for example, liposomes, receptor targeted molecules, oral, rectal, topical or other formulations, for assisting in uptake, distribution and/or absorption. Representative United States patents that teach the preparation of such uptake, distribution and/or absorption assisting formulations include U.S. Pat. Nos. 5,108,921; 5,354,844; 5,416,016; 5,459,127; 5,521,291; 5,543,158; 5,547,932; 5,583,020; 5,591,721; 4,426,330; 4,534,899; 5,013,556; 5,108,921; 5,213,804; 5,227,170; 5,264,221; 5,356,633; 5,395,619; 5,416,016; 5,417,978; 5,462,854; 5,469,854; 5,512,295; 5,527,528; 5,534,259; 5,543,152; 5,556,948; 5,580,575; and 5,595,756, each of which is herein incorporated by reference.

Casein Kinase 1A1

As reported in detail herein below, casein kinase 1A1 (CSNK1A1) was identified as a target of lenalidomide in del(5q) myelodysplastic syndrome (MDS). Methods for characterizing the biological activity of lenalidomide, thalidomide, and pomalidomide have been hampered because mice have been largely unresponsive to the activity of these compounds. Significantly, as reported herein below, expression of human CRBN in murine cells was sufficient to confer lenalidomide sensitivity to CSNK1A1. Moreover, mutation of murine CRBN to include at least one of I391V, or any other substitution, deletion or addition of the murine CRBN that confers lenalidomide sensitivity to CSNK1A1, IKZF1 and IKZF3 is also included. Accordingly, the present invention provides murine cells and transgenic animals expressing human CRBN or mutant CRBN.

In other embodiments, the invention provides for the use of casein kinase 1A1 inhibitors for the treatment of a B cell neoplasia or related condition. Casein kinase 1A1 and casein kinase 1 inhibitors are useful in the methods of the invention. In particular embodiments, casein kinase 1 inhibitors include, but are not limited to, Casein Kinase I Inhibitor, D4476 (CAS 301836-43-1) (Santa Cruz Biotechnology).

In yet other embodiments, the invention includes knock-down or inhibition of casein kinase 1A1 expression for the treatment of a B cell neoplasia or related condition. Knock-down or inhibition of expression of casein kinase 1A1 is useful in the methods of the invention to confer sensitivity to lenalidomide or a lenalidomide analog. In particular embodiments, casein kinase 1 expression is decreased by a method including, but are not limited to, antisense nucleic acid molecule, siRNA molecule, shRNA, CRISPR, CRISPRi (Cell 152 (5): 1173-83, 2013) and other known method for decreasing gene expression.

Generation of a Transgenic Mouse that is Responsive to Lenalidomide and Other IMiDs

Generating transgenic mice involves five basic steps: purification of a transgenic construct, harvesting donor zygotes, microinjection of transgenic construct, implantation of microinjected zygotes into the pseudo-pregnant recipient mice, and genotyping and analysis of transgene expression in founder mice. Methods for the generation of transgenic mice are known in the art and described, for example, by Cho et al., Curr Protoc Cell Biol. 2009 March; CHAPTER: Unit-19.11, which is incorporated herein in its entirety.

An expression vector, such as an expression vector encoding human CRBN or an expression vector encoding a mutant CRBN (e.g., S369C, V380E, or I391V), is generated using standard methods known in the art. Construction of transgenes can be accomplished using any suitable genetic engineering technique, such as those described in Ausubel et at (Current Protocols in Molecular Biology, John Wiley & Sons, New York, 2000). Many techniques of transgene construction and of expression constructs for transfection or transformation in general are known and may be used to generate the desired human CRBN-expressing construct.

One skilled in the art will appreciate that a promoter is chosen that directs expression of the CRBN gene in all tissues or in a preferred tissue. In particular embodiments, CRBN expression is driven by a phosphoglycerate kinase 1 promoter (PGK1) (Qin et al. (2010) PLoS ONE 5(5): e10611. doi:10.1371/journal.pone.0010611), the spleen focus-forming virus (SFFV) (Gonzalez-Murillo et al., Hum Gene Ther. 2010 May; 21(5):623-30, using knockin technology (Cohen-Tannoudji et al., Mol Hum Reprod 4:929-938, 1998; Rossant et al., Nat Med 1:592-594, 1995; tet-off promoter (Clontech), human EF1s, CMV or endogenous CRBN promotor. The modular nature of transcriptional regulatory elements and the absence of position-dependence of the function of some regulatory elements, such as enhancers, make modifications such as, for example, rearrangements, deletions of some elements or extraneous sequences, and insertion of heterologous elements possible. Numerous techniques are available for dissecting the regulatory elements of genes to determine their location and function. Such information can be used to direct modification of the elements, if desired. Preferably, an intact region that includes all of the transcriptional regulatory elements of a gene is used.

Following its construction, the transgene construct is amplified by transforming bacterial cells using standard techniques. Plasmid DNA is then purified and treated to remove endogenous bacterial sequences. A fragment suitable for expression of a transgenic CRBN under the control of a suitable promoter, such as an endogenous murine CRBN promoter, and optionally additional regulatory elements is purified (e.g., by a sucrose gradient or a gel-purification method) in preparation for microinjection.

Foreign DNA is transferred into a mouse zygote by microinjection into the pronucleus. A fragment of the transgene DNA isolated above is microinjected into the male pronuclei of fertilized mouse eggs derived from, for example, a C57BL/6 or C3136 F1 strain, using the techniques described in Gordon et al. (Proc. Natl. Acad. Sci. USA 77:7380, 1980). The eggs are transplanted into pseudopregnant female mice for full-term gestation, and resultant litters are analysed to identify transgenic mice.

The practice of the present invention employs, unless otherwise indicated, conventional techniques of molecular biology (including recombinant techniques), microbiology, cell biology, biochemistry and immunology, which are well within the purview of the skilled artisan. Such techniques are explained fully in the literature, such as, “Molecular Cloning: A Laboratory Manual”, second edition (Sambrook, 1989); “Oligonucleotide Synthesis” (Gait, 1984); “Animal Cell Culture” (Freshney, 1987); “Methods in Enzymology” “Handbook of Experimental Immunology” (Weir, 1996); “Gene Transfer Vectors for Mammalian Cells” (Miller and Calos, 1987); “Current Protocols in Molecular Biology” (Ausubel, 1987); “PCR: The Polymerase Chain Reaction”, (Mullis, 1994); “Current Protocols in Immunology” (Coligan, 1991). These techniques are applicable to the production of the polynucleotides and polypeptides of the invention, and, as such, may be considered in making and practicing the invention. Particularly useful techniques for particular embodiments will be discussed in the sections that follow.

The following examples are put forth so as to provide those of ordinary skill in the art with a complete disclosure and description of how to make and use the assay, screening, and therapeutic methods of the invention, and are not intended to limit the scope of what the inventors regard as their invention.

EXAMPLES Example 1 DNA Damage Binding Protein 1 (DDB1) and Carbonyl Reductase 1 (CBR1) Bind to Lenolidomide

Lenalidomide is a highly effective drug for the treatment of multiple myeloma (Rajkumar et al., Blood 106, 4050 (Dec. 15, 2005).) and del(5q) MDS (List et al., N Engl J Med 352, 549 (Feb. 10, 2005)), and its use in a range of other conditions is being actively explored, but the precise mechanism of action of lenalidomide has not been established. In addition, lenalidomide and its analogues thalidomide and pomalidomide have multiple additional biological effects, including stimulation of IL-2 production by T cells, and inhibition of TNF production by monocytes, but the molecular basis of these pleiotropic activities is unknown.

In order to identify direct protein targets of lenalidomide, a derivative of lenalidomide was synthesized that allowed immobilization of the molecule to a bead (FIG. 2A). This derivative retained the biological activity of lenalidomide, including selective growth inhibition of multiple myeloma cells (FIG. 2B). To identify proteins that bind to the lenalidomide derivative immobilized on a solid support, SILAC (Stable Isotope Labeling of Amino Acids in Cell Culture)-based quantitative mass spectrometry (MS) was used to compare proteins pulled down by beads in the presence or absence of 100-fold excess soluble lenalidomide, enabling discrimination between proteins that bind lenalidomide from those binding the bead or linker (FIG. 2C).

This approach identified two candidate proteins binding specifically to lenalidomide, DNA damage binding protein 1 (DDB1) and carbonyl reductase 1 (CBR1). DDB1 binds the lenalidomide derivative-immobilized beads, and was competed off by lenalidomide, thalidomide, and pomalidomide. Lenalidomide did not interact with CBR1 in direct binding assays or inhibit CBR1 in biochemical assays so it was not pursued further. Recently, Ito et al. reported a similar proteomic strategy leading to the finding that thalidomide binds to DDB1 via CRBN, and that this interaction is necessary for thalidomide's teratogenic effects. DDB1 forms an E3 ubiquitin ligase (CRL4) with Cullin 4A and 4B (Cul4A/4B) and regulator of cullins 1 (RBX1). Consistent with these findings, it was found that DDB1 and CRBN each bound the lenalidomide derivative beads and were competed off by soluble lenalidomide. The finding that CRBN-DDB1 binds both lenalidomide and thalidomide in independent proteomic studies provided powerful evidence that this ubiquitin ligase complex is a major direct protein binding partner for this class of molecules.

It was hypothesized that the pleiotropic effects of lenalidomide might be caused by altered ubiquitination of target proteins. Specificity of the CRL4 ubiquitin ligase is mediated by an interchangeable substrate receptor, but no targets have been identified for CRBN, a putative substrate receptor. To characterize drug-induced modulation of CRL4-CRBN ubiquitin ligase activity, SILAC-based quantitative MS studies were used to characterize changes in the ubiquitinome and proteome in the MM1S multiple myeloma cell line cultured in the presence of lenalidomide or thalidomide for 12 hours (FIG. 1A, 1C). Ubiquitination profiling was completed by enrichment of formerly ubiquitinated peptides with an anti-K-ε-GG antibody (FIG. 1B). In parallel, the landscape of lenalidomide-dependent CRBN protein interactions was examined (FIG. 1D, 4).

Example 2 Lenalidomide Regulates Ikaros (IKZF1) and Aiolos (IKZF3)

Two proteins, Ikaros (IKZF1) and Aiolos (IKZF3), scored at the top of the lists of proteins regulated by lenalidomide at both the protein and ubiquitin-site level (FIG. 1C, 1D). Lenalidomide decreased the abundance of IKZF3 (log₂ ratio −2.09) and IKZF1 (log₂ ratio −1.54). While increased ubiquitination would be expected to be associated with decreased protein abundance, a decrease in ubiquitination of multiple lysine residues of IKZF1 and IKZF3 was observed after treating cells with lenalidomide for 12 hours prior to addition of the proteasome inhibitor MG132. A likely interpretation of these results is that IKZF1 and IKZF3 are rapidly ubiquitinated, targeting them for degradation and thereby resulting in a decrease in abundance of both ubiquitinated and absolute levels of these proteins. IKZF1 and IKZF3 also scored at the top of the list of thalidomide-regulated proteins, consistent with the similar biological activity of the molecules (FIGS. 3A and 3B).

Strikingly, the protein interaction study using HA-CRBN revealed binding of IKZF1 and IKZF3 to the putative CRBN substrate receptor in the presence of lenalidomide (FIGS. 5A and 5B). As expected, all of the members of the CRBN-CRL4 ubiquitin ligase and proteins known to interact with DDB1 including subunits 1 to 8 of the COP9 signalosome complex CSN, DDA1, and DNA ligase 4 were pulled down in both untreated or lenalidomide treated cells. No other substrate receptors for DDB1 were co-immunoprecipitated, Based on these results it is likely that CRBN is a substrate receptor and precludes binding of alternative receptors to DDB1. In aggregate, the proteomic data indicate that lenalidomide increases the binding of IKZF1 and IKZF3 to the CRBN-DDB1 ubiquitin ligase complex, leading to increased ubiquitination and consequent degradation.

To validate this putative mechanism, the question of whether lenalidomide causes post-transcriptional regulation of IKZF1 and IKZF3 protein abundance was analyzed. The cDNAs of candidate genes, fused to firefly luciferase (FFluc), were expressed in 293T cells. IKZF1 and IKZF3 conferred a lenalidomide-regulated decrease in protein abundance onto the fused FFLuc. In contrast, luciferase levels were not altered after lenalidomide treatment when FFluc was fused to RAB28, a protein that decreased in abundance after lenalidomide treatment but did not bind to CRBN. Similarly, lenalidomide did not alter the abundance of FFluc fused to three other transcription factors of the Ikaros family, Helios (IKZF2), Eos (IKZF4) and Pegasus (IKZF5); IRF4, a protein implicated in lenalidomide activity; or the transcription factors HOXA9 and Myc (FIG. 6A). It was confirmed that, in MM1S multiple myeloma cells stably expressing HA-IKZF1 or HA-IKZF3, lenalidomide caused a dose-dependent reduction of both proteins (FIG. 6B). Taken together, these results demonstrate the selective regulation of IKZF1 and IKZF3 levels in response to lenalidomide.

Endogenous protein expression was examined in response to lenalidomide. Lenalidomide strongly decreased the abundance of IKZF1 and IKZF3 in a dose-dependent manner in MM1S cells (FIG. 6C), in primary cells (FIG. 6E) and other cell lines (FIGS. 7A and 7B). Depletion of these proteins was evident in as little as 3 hours after treatment. In contrast, IKZF1 and IKZF3 mRNA levels were not altered by lenalidomide treatment (FIG. 6D). FIG. 6F shows an in vivo ubiquitination analysis of HA-tagged IKZF1 and IKZF3 expressed in MM1S cells treated for 1.5 hours with 100 nM Epoxomicin and the indicated concentrations of lenalidomide. The FK2 antibody detects covalently linked ubiquitin.

Example 3 Lenalidomide Induced Ubiquitination of IKZF1 and IKZF3

The direct effect of lenalidomide on ubiquitination of IKZF1 and IKZF3 was assessed. Lenalidomide induced dose-dependent ubiquitination of tagged IKZF1 and IKZF3 in MM1S and 293′ cells (FIG. 8A-8C). Cain-RING ubiquitin ligase (CRL) activity depends on NEDDylation and can be inhibited by the Nedd8 enzyme inhibitor MLN4924. Treatment with 1 μM MLN-4924 prevented the lenalidomide-induced decrease of endogenous IKZF1 and IKZF3 in MM1S cells and of FFluc-fused IKZF3 in 293T cells. These experiments demonstrate that lenalidomide-induced degradation of IKZF1 and IKZF3 involves ubiquitination by a cullin-based E3 ubiquitin ligase.

Experiments were carried out to determine whether lenalidomide-induced ubiquitination of IKZF1 and IKZF3 is caused by altered binding of these proteins to CRBN, as observed in our proteomic studies. These experiments confirmed that more IKZF1 and IKZF3 co-irnmunoprecipitate with HA-CRBN after 3 hours of lenalidomide treatment, despite a dramatic decrease of protein levels in the whole cell lysate at the same time (FIG. 9A). If CRBN is essential for lenalidomide-induced degradation of IKZF1 and IKZF3, then loss or mutation of CRBN would inhibit the effect of the drug. Consistent with this, it was found that shRNA knockdown of CRBN prevented lenalidomide-induced degradation of luciferase fusions of IKZF1 and IKZF3, and prevented degradation of HA-tagged IKZF3 in 293T cells (FIG. 9B, 9C). Similarly, the CRBN^(YWAA) mutant that does not bind lenalidomide abrogated degradation of IKZF1 and IKZF3 (FIG. 9D) and conferred lenalidomide resistance to MM1S cells (FIG. 10), consistent with previous studies that have shown CRBN to be essential for lenalidomide activity in multiple myeloma. These studies demonstrate that lenalidomide causes increased binding of IKZF1 and IKZF3 to CRBN, and that CRBN is critical for the effects of lenalidomide on these proteins.

To assess whether IKZF3 is an enzymatic substrate of the CRBN-DDB1 E3 ubiquitin ligase, an in vitro ubiquitination assay was performed. HA-IKZF3 was co-immunoprecipitated by FLAG-CRBN from 293T cells treated with DMSO or lenalidomide. Lenalidomide was added to the protein lysate in order to achieve efficient co-immunoprecipitation of IKZF3. The eluted complex was then incubated in the ubiquitin reaction mixture. Ubiquitinated IKZF3 could only be detected in reactions containing E1 and E2 ubiquitin ligase enzymes and was increased in cells pre-treated with lenalidomide, demonstrating that IKZF3 gets ubiquitinated when bound to CRBN.

Example 4 Amino Acids 131 to 270 of IKZF3 Mediate Lenalidomide Sensitivity

In order to identify a degron sequence in IKZF3 responsible for lenalidomide sensitivity, a series of IKZF3 cDNA deletion mutants was generated. Amino acids 131 to 270 of IKZF3 were identified as necessary and sufficient for lenalidomide sensitivity. Amino acids 141 to 180 were necessary for the lenalidomide response. The critical amino acid sequence lies within zinc finger domain 2, which is highly homologous between IKZF1 and IKZF3. IKZF2, IKZF4, and IKZF5, proteins that are not sensitive to lenalidomide-induced degradation, differ from IKZF1 and IKZF3 at three amino acids within this region. Substitution of Q147 in IKZF3 with a histidine residue (IKZF3 Q147H), which is present at this corresponding site in IKZF2 and IKZF4 resulted in resistance to lenalidomide-induced degradation (FIG. 10). Conversely, when the corresponding histidine (H188) in IKZF4 is changed to glutamine (IKZF4 H188Q), IKZF4 was degraded after lenalidomide treatment (FIG. 9G). In addition, Q150H and further point mutations in the essential region of IKZF3 were identified that rendered IKZF3 resistant towards lenalidomide (FIG. 11A-11C). Binding to CRBN in the presence of lenalidomide is decreased for Q147H and Q150H mutants compared to wildtype IKZF3 (FIG. 11C). This domain is therefore necessary and sufficient for lenalidomide-induced binding to CRBN and subsequent protein degradation, and amino acid changes in this region provide the basis for differential sensitivity to lenalidomide between Ikaros family members.

Example 5 IKZF1 and IKZF3 Depletion Mediates Lenalidomide's Anti-Proliferative Effect in Multiple Myeloma Cells

Having demonstrated that lenalidomide regulates IKZF1 and IKZF3 ubiquitination and abundance, experiments were carried out to determine whether these proteins mediate specific biological and therapeutic effects of lenalidomide. IKZF1 and IKZF3 are essential transcription factors for terminal differentiation of B and T cell lineages. While IKZF1 is highly expressed in early lymphoid progenitors, IKZF3 is expressed at high levels in more mature B cell neoplasms, and murine studies have demonstrated that IKZF3 is required for the generation of plasma cells, the physiologic counterparts of multiple myeloma cells. Therefore, the dependence of multiple myeloma cells on IKZF1 and IKZF3 expression by genetic silencing of these proteins was assessed using RNA interference. IKZF1 and IKZF3 shRNAs that effectively decreased expression of the target proteins (FIG. 15A-15C) inhibited growth of lenalidomide-sensitive multiple myeloma cell lines, while lenalidomide insensitive cell lines were unaffected (FIG. 12A and FIG. 13). Similarly, expression of a dominant negative IKZF3 isoform that lacks the complete DNA binding region resulted in depletion of MM1S cells (FIG. 12B). Over-expression of IKZF3 conferred relative lenalidomide-resistance to MM1S cells when competed with MM1S cells infected with a control retrovirus (FIG. 12C). Moreover, MM1S cells expressing the lenalidomide-resistant IKZF3 Q150H mutation were relatively resistant towards lenalidomide when competed to MM1S cells expressing wild-type IKZF3. These studies indicate that the anti-proliferative effect of lenalidomide in multiple myeloma cells is mediated by depletion of IKZF1 and IKZF3.

The transcription factor IRF4 was previously reported to be an important gene in multiple myeloma, and was implicated in the activity of lenalidomide in this disease (Y. Yang et al., Cancer Cell 21, 723 (Jun. 12, 2012)., A. L. Shaffer et al., Nature 454, 226 (Jul. 10, 2008).). While IRF4 levels were only slightly decreased in a proteomic analysis, performed on cells treated with lenalidomide for 12 hours, a significant decrease of IRF4 mRNA and protein was observed when cells were treated for 24 hours and longer. Knockdown of IKZF3 also suppressed IRF4 mRNA levels, suggesting that lenalidomide regulates IRF4 through Ikaros-mediated transcriptional repression (FIG. 14A-14E).

Example 6 Knockdown of IKZF3 Induced IL2 Expression

IKZF3 binds the IL2 gene promoter and repressed IL2 transcription in T cells. Experiments were carried out to determine whether lenalidomide regulates IL2 levels by modulating IKZF3 expression. Both IKZF1 and IKZF3 protein levels decreased markedly in primary human T cells treated with lenalidomide (FIG. 12D). Lentiviral shRNA-mediated knockdown of IKZF3 induced IL2 expression. Lenalidomide induced IL2 mRNA expression by 3.3-fold in T cells expressing a control shRNA, and this induction was blocked by IKZF3 knockdown (FIG. 12E). Similarly, the effect of lenalidomide on IL2 expression was abrogated by shRNA knockdown of CRBN (FIG. 12F). These studies demonstrated that one of the primary immunomodulatory activities of lenalidomide, induction of IL2, is mediated by de-repression of the IL2 promoter by depletion of IKZF3.

In aggregate, the studies reported herein above demonstrate that lenalidomide acts via a novel mechanism of drug activity, enforced binding of the substrate receptor CRBN to IKZF1 and IKZF3, resulting in selective ubiquitination and degradation of the target proteins. IKZF1 and IKZF3 play central roles in the biology of B and T cells, and ablation of protein expression for these transcription factors explains the activity of lenalidomide in lymphoid cells. In particular, IKZF3 is critical for plasma cell development, and these data indicate that IKZF3 is important in multiple myeloma, a plasma cell malignancy, providing a mechanistic basis for therapeutic efficacy in this disorder. Moreover, the activity of lenalidomide in other B cell neoplasms, including mantle cell lymphoma and chronic lymphocytic leukemia, may be explained by high IKZF3 expression in these disorders. In contrast to the high expression and essentiality of IKZF1 and IKZF3 in mature B cells, somatic genetic inactivation of the IKZF1 and IKZF3 occurs in acute lymphoblastic leukemia, resulting in an accumulation of immature lymphoid progenitor cells (C. G. Mullighan et al., Nature 446, 758 (Apr. 12, 2007); S. Winandy et al., Cell 83, 289 (Oct. 20, 1995)). In T cells, ablation of IKZF3-mediated repression of IL2 gene expression provides a mechanism for increased IL2 production in response to lenalidomide. The teratogenicity of thalidomide and the efficacy of lenalidomide in MDS may be mediated by alternative substrates in different cellular lineages.

RING-based E3 ubiquitin ligases are characterized by a high specificity for their substrates and therefore represent promising drug targets in cancer and other diseases. Following the identification of an E3 ubiquitin ligase as a target of thalidomide and lenalidomide, inhibition of enzymatic activity would have seemed a more likely mechanism of action. The results reported herein reveal that lenalidomide modulates the activity of the CRL4-CRBN complex to increase ubiquitination of two transcription factors, IKZF1 and IKZF3 that would otherwise be considered “undruggable.” A plant hormone, auxin, appears to act similarly, increasing the interaction between a ubiquitin ligase and a specific substrate, suggesting that this mechanism might be operative in additional biological contexts. Selective ubiquitination and degradation of specific targets provides a novel mechanism of therapeutic activity for proteins that are not otherwise amenable to small-molecule inhibition.

Example 7 Lenalidomide Treatment Reduced CSNK1A1 Levels in Murine Cells Over-Expressing Human CRBN

To determine whether mouse and human cells responded similarly, cell lines were treated with lenalidomide (FIG. 16). Lenalidomide decreased CSNK1A levels in all human cell lines expressing CRBN (see FIG. 17). FIG. 18 shows that levels of the short and long forms of casein kinase were not reduced in bone marrow from mice treated with lenalidomide. Similarly, murine casein kinase 1 levels were not reduced in spleen in response to lenalidomide (FIG. 18). No change in CSKN1A levels was seen in Murine baf-3 cells or in primary MLL-AF9 transformed mouse cells. In contrast, lenalidomide treatment reduced CSNK1A1 levels in murine cells over-expressing human CRBN (FIG. 19). CSNK1A1 was used as a readout because CSNK1A1 decreased after being treated with Lenolidomide. hCRBN was clearly more sensitive to Lenalidomide than mCRBN (FIG. 19).

Example 8 Lenalidomide Induces Ubiquitination and Degradation of Casein Kinase 1A1 Via CRL4^(CRBN)

Lenalidomide is a highly effective treatment for myelodysplastic syndrome (MDS) with deletion of chromosome 5q (del(5q)), inducing cytogenetic remission in more than 50% of patients. No biallelic deletions or loss of function mutations on the remaining allele have been detected in any of the genes located in the commonly deleted regions of in del(5q) MDS, implying that del(5q) MDS is a haploinsufficiency disease. MDS patients without del(5q) are much less sensitive to lenalidomide, suggesting that haploinsufficiency for a gene on chromosome 5q causes selective sensitivity of the MDS cells to the drug. Recently, it has been demonstrated that lenalidomide acts to modulate CRBN-CRL4 E3 ubiquitin ligase. Ubiquitination and degradation of the transcription factors, IKZF1 and IKZF3, by lenalidomide is responsible for two major properties of IMiDs: growth inhibition of multiple myeloma cells and interleukin-2 release from T-cells. However, it is unlikely that degradation of these lymphoid transcription factors also accounts for therapeutic activity in del (5q) MDS. Instead, it is possible that ubiquitination of a different CRBN substrate in myeloid cells accounts for the efficacy of lenalidomide in del(5q) MDS.

In order to identify such substrates. SILAC (stable isotope labeling of amino acids in cell culture)-based quantitative mass spectrometry was applied to assess global changes in ubiquitination and protein levels in the myeloid cell line KG-1. Similar to the analysis in multiple myeloma, lenalidomide altered the ubiquitination and protein levels of a strikingly low number of proteins, demonstrating the highly specific effects of the drug on ubiquitin ligase function. Consistent with previous studies, lenalidomide treatment decreased ubiquitination of CRBN and increased ubiquitination of IKZF1, followed by the corresponding changes in protein levels. Aside from IKZF1, casein kinase 1A1 (CSNK1A1, also known as CK1α) had the greatest increase in ubiquitination and decrease in protein abundance following lenalidomide treatment. CSNK1A1 is encoded by a gene in the del(5q) commonly deleted region and has been shown to be a therapeutic target in AML, and is thus an attractive candidate for mediating the effects of lenalidomide in del(5q) MDS (FIGS. 20A, 20B and FIGS. 24A-24C)

Based on the proteomics results, validation that CSNK1A1 is a lenalidomide-dependent target of the CRBN-CRL4 ubiquitin ligase was sought. It was confirmed that lenalidomide treatment decreased CSNK1A1 protein levels in multiple human cell lines in a dose-dependent fashion (FIGS. 20C, 24D, 25A-25B), decreased the half-life of the CSNK1A1 protein, and did not alter CSNK1A1 mRNA levels (FIGS. 20D and 25C). The lenalidomide-induced decrease in CSNK1A1 protein levels was abrogated by treatment with the proteasome inhibitor MG132 and the NEDD8-activating enzyme inhibitor, MLN-4924, which interferes with the activity of cullin-RING E3 ubiquitin ligases (FIG. 21A). Cells with homozygous genetic inactivation of the CRBN gene by CRISPR-Cas genome engineering were not responsive to lenalidomide (FIG. 21B). Finally, it was demonstrated that CSNK1A1 co-immunoprecipitates with hemagglutinin (HA)-tagged CRBN, and that lenalidomide increases this association (FIG. 21D). Co-transfection of CRBN with HA-CSNK1A1 promoted lenalidomide-induced ubiquitination of the tagged CSNK1A1 in 293T cells (FIGS. 21B, 21D). In aggregate, these experiments indicate that CSNK1A1 is a CRBN-CRL4 E3 ligase substrate that is ubiquitinated and degraded in the presence of lenalidomide.

Next, it was examined whether CK1α binds CRBN and is ubiquitinated by the CRL4^(CRBN) E3 ubiquitin ligase. CK1α co-immunoprecipitated with FLAG-tagged CRBN only in the presence of lenalidomide (FIG. 21C). Lenalidomide treatment increased the ubiquitination of FLAG-CK1α in 293T cells (FIG. 21D).

The effects of CSNK1A1 depletion on cell proliferation were assessed. CSNK1A1 is a serine/threonine kinase with multiple cellular activities, including the suppression of TP53 and β-catenin activity. Complete loss of CSNK1A1 induces apoptosis in normal and leukemic stem cells via p53 activation, while heterozygous loss of CSNK1A1 causes stem cell expansion with β-catenin activation. Since p53 activation occurs when CSNK1A1 levels are less than 50% of normal, haploinsufficiency of CSNK1A1 in del (5q) MDS was thought to sensitize cells to a further decrease in CSNK1A1 expression. To address this hypothesis, primary human CD34⁺ hematopoietic stem and progenitor cells were transduced with lentiviral vectors expressing GFP, as well as CSNK1A1 or control shRNAs. Cells expressing CSNK1A1 shRNAs were depleted in the absence of treatment, confirming that CSNK1A1 depletion inhibited growth of hematopoietic cells. (FIGS. 21E, 21F) The addition of lenalidomide enhanced the depletion of CSNK1A1 shRNA expressing cells, but not cells expressing control shRNAs, demonstrating that reduced CSNK1A1 levels sensitized hematopoietic cells to lenalidomide (FIGS. 21E, 21F, 26B, 26C).

It was determined whether haploinsufficiency for Csnk1a1 sensitizes cells to lenalidomide in a genetically engineered mouse model. In initial experiments, it was found that lenalidomide did not decrease Csnk1a1 protein levels in murine Baf3 cells or primary murine leukemia cells treated with lenalidomide (FIG. 22A, 27A, 27B). Mice did not develop the specific limb deformations observed in human embryos exposed to thalidomide and primary murine multiple myeloma did not respond to lenalidomide, suggesting that murine cells were intrinsically resistant to IMiDs. Since CRBN is a direct protein target of lenalidomide, it was examined whether expression of the human CRBN could confer drug sensitivity onto murine cells. Overexpression of human, but not murine CRBN, in murine cells resulted in a decrease of CSNK1A1 protein levels, implying amino acid differences between murine CRBN (mCRBN) and human CBRN (hCRBN) were responsible for species-specific response to lenalidomide (FIGS. 22B, 22C, 27A, 27B).

In order to determine the amino acids responsible for the differential sensitivity to lenalidomide between species, a series of human/mouse CRBN chimeric cDNAs and point mutations were tested. A single amino acid in the C-terminus of CRBN (residue I391 (murine) and V387 (human)) was identified that determined the response to lenalidomide. (FIG. 22C, 27C) Expression of a murine CRBN mutant (mCRBN^(I391V)) conferred sensitivity to lenalidomide-induced degradation of CSNK1A1 in Baf3 cells. (FIG. 22D) Conversely, expression of the reciprocal human CRBN^(V387I) abrogated sensitivity to lenalidomide in human cells (FIG. 22E). Amino acid 387 of CRBN is located in the IMiD-binding region described by Ito et al., and in close proximity to the CRBN^(Y383A,W385A) mutant that does not bind to IMiDs.

Having determined the mechanism of lenalidomide resistance in murine cells, the mCRBN^(I391V) cDNA was expressed in hematopoietic cells from Csnk1a1 conditional knockout mice to determine the effects of Csnk1a1 haploinsufficiency on drug sensitivity. c-Kit⁺ hematopoietic stem and progenitor cells were isolated from Csnk1a1^(+/−) and control littermates, transduced with a retroviral vector expressing mCRBN^(I391V), and cultured in competition with a neutral comparator line, SJL, in the presence or absence of lenalidomide (FIG. 23A). Lenalidomide had no effect on the control cells, but Csnk1a1^(+/−) cells were significantly depleted in the presence of lenalidomide (FIG. 23B). The enhanced sensitivity of Csnk1a1^(+/−) cells to lenalidomide was associated with induction of the p53 target gene p21 (FIG. 23C) and rescued by heterozygous deletion of p53 (FIG. 23D), demonstrating a critical down-stream role for p53. These results were consistent with the clinical observation that p53 mutations conferred lenalidomide resistance in MDS with del(5q).

This study demonstrated that the efficacy of lenalidomide in del(5q) MDS was mediated by targeted degradation of a haploinsufficient protein, CSNK1A1. Loss of CSNK1A1 induces p53 activity, and other deleted genes on chromosome 5q, such as RPS14, which may further sensitize cells to p53 activation. Degradation of CSNK1A1 may also contribute to other clinical effects of lenalidomide such as myelosuppression. CSNK1A1 degradation may be involved in the clinical activity of lenalidomide in lymphoid malignancies, including the activated B-cell (ABC) subtype of diffuse large B-cell lymphoma, which requires CSNK1A1 for constitutive NF-κB activity, and multiple myeloma cells.

The concept that genes within heterozygous deletions could cause vulnerabilities in cancer cells has been confirmed in these cell lines. Heterozygous deletion of CSNK1A1 was demonstrated to create such vulnerability in del(5q) MDS cells, and that lenalidomide-induced degradation of this protein resulted in major significant clinical efficacy. Induction of ubiquitination and degradation of other haploinsufficient proteins may provide a basis for the development of new targeted therapies in cancer.

The results described in Examples 1-6 were carried out using the following methods and materials.

Synthesis of Lenalidomide Derivative

NMR spectra were recorded on Bruker DRX-600, DRX-500, and AMX-400 instruments and calibrated using residual undeuterated solvent as an internal reference (CHCl₃ @ 7.26 ppm 1H NMR, 77.16 ppm 13C NMR). The following abbreviations (or combinations thereof) were used to explain the multiplicities: s=singlet, d=doublet, t=triplet, ap=apparent, m=multiplet, b=broad, ABq=AB quartet.

Compounds were purified by mass-directed purification on a Waters Autopurification system (Milford, Mass.). Collection was triggered on the (M+H)+ and (M+Na)+ ions on a ZQ mass spectrometer using positive electrospray ionization. Mobile phase A consisted of 0.2% ammonium hydroxide in water, while mobile phase B consisted of 0.2% ammonium hydroxide in acetonitrile. An initial hold at 0% mobile phase B for 1.0 minutes was followed by a gradient from 0% to 100% mobile phase B over 11.0 minutes at 24 mL/min. A 2.0 ml/min at-column dilution was present using 100% acetonitrile as well as a 2.0 mL/min make-up flow using 90/10/0.1 methanol/water/formic acid. An XBridge OBD Prep C18, 5 um, 19×100 mm column was used at room temperature.

Preparation of N-butyl-4-((2-(2,6-dioxopiperidin-3-yl)-1-oxoisoindolin-4-yl)amino)butanamide (lenaderivative)

Lenalidomide (30 mg, 0.116 mmol) and succinic semialdehyde (0.075 ml, 0.116 mmol) (15% in water) were dissolved in DMF (0.4 ml) and AcOH (8.16 μl). The reaction was stirred at room temperature for 1 hour. Sodium triacetoxyborohydride (36.8 mg, 0.174 mmol) was then added and the reaction is maintained at room temperature. After 4 hours, additional succinic semialdehyde (0.075 ml, 0.116 mmol) and sodium triacetoxyborohydride (36.8 mg, 0.174 mmol) were added and the reaction was stirred for a further 16 hours at room temperature. The reaction mixture was diluted with MeOH, concentrated and purified by HPLC purification to afford the desired carboxylic acid (4-((2-(2,6-dioxopiperidin-3-yl)-1-oxoisoindolin-4-yl)amino)butanoic acid) (16.2 mg, 41%). MS (ESI) calcd for C₁₇H₁₉N₃O₅ [M+H]+: 345. Found: 346. The Lenalidomide carboxylic acid derivative (7 mg, 0.020 mmol) was dissolved in DMF (0.5 mL). N-Hydroxysuccinimide (2.333 mg, 0.020 mmol) and 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (5.83 mg, 0.030 mmol) were then added. After 15 minutes, n-butylamine (10.02 μL, 0.101 mmol) was added. The reaction mixture was concentrated and purified by HPLC purification to afford the desired amide (lenaderivative) (2.6 mg, 32%). MS (ESI) calcd for C₂₁H₂₈N₄O₄ [M+H]+: 400. Found: 401. ¹H NMR (300 MHz, M CD3OD) δ 8.51 (bs, 1H), 7.31 (ap t, J=7.8 Hz, 1H), 7.06 (d, J=7.5 Hz, 1H), 6.81 (d, J=8.1 Hz, 1H), 5.14 (dd, J=13.3, 5.2 Hz, 1H), 4.30, 4.23 (ABq, J_(AB) 16.9 Hz, 2H), (3.29-3.02 (m, 4H), 2.97-2.69 (m, 2H), 2.57-2.35 (m, 1H), 2.29 (ap t, J=7.3 Hz, 2H), 2.21-2.07 (m, 1H), 1.99-1.84 (m, 2H), 1.61-1.17 (m, 4H), 0.90 (t, J=7.2 Hz, 3H).

Immobilization of the Lenalidomide Derivative onto Affigel Beads

The solid-phase beads used in small molecule immobilization were Affigel 102 (Bio-Rad) with a loading level of 12 μmol/mL suspension. The bead suspension (1.0 mL) was transferred to a 2.0 mL eppendorf tube and washed with DMSO (6×1.5 mL). The beads were then suspended in anhydrous DMSO (0.5 mL).

The lenalidomide-derived carboxylic acid (4-((2-(2,6-dioxopiperidin-3-yl)-1-oxoisoindolin-4-yl)amino)butanoic acid) (0.277 mL, 10 μmol) was dissolved in DMSO (0.5 mL) and to this were added N-hydroxysuccinimide (1.151 mg, 10.00 μmol) and 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (2.88 mg, 15.00 μmol). After 45 minutes further N-hydroxysuccinimide (4 mg, 35 μmol) and 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (6 mg, 31 μmol) were added and the reaction mixture was stirred for a further 60 minutes. At this point LC-MS indicated 60% of the carboxylic acid had been activation with N-hydroxysuccinimide. To achieve a 12.5% loading level of the Affigel beads, 1.5 μmol of activated compound was added to the suspended beads. Thus the activated acid solution was added to the bead suspension followed by triethylamine (8.36 μL, 60.0 μmol). The suspension was then vortexed at room temperature for 1 hour and the depletion of free activated bait molecule was monitored by LC-MS. After the immobilization, the vials were centrifuged, the supernatant was removed and the beads were washed with DMSO (3×2 mL) and 1-120 (3×2 mL). The heads were subsequently suspended in PBS (0.8 mL) and stored at 4° C. before use.

SILAC Media Preparation and Cell Culture Conditions

All standard SILAC media preparation and labeling steps were as previously described (E.Ong, Nature protocols 1, 2650 (2006)) with the addition of light proline to prevent the conversion of arginine to proline (S. C. Bendall et al., Mol Cell Proteomics 7, 1587 (September, 2008)). Briefly, L-methionine and 200 mg/L of L-Proline were added to base media according to standard formulations for RPM (Caisson Labs) or DMEM (Caisson Labs). This base media was divided into three and to each added 1-arginine (Arg0) and 1-lysine (Lys0) (light), 13C614N4-1-arginine (Arg6) and 4,4,5,5-D4-1-lysine (Lys4) (medium) or 13C615N4-1-arginine (Arg10) and 13C615N2-1-Lysine (Lys8) (heavy) to generate the three SILAC labeling mediums. Each medium with the full complement of amino acids at the standard concentration for each media, was sterile filtered through a 0.22μ filter (Milipore, Bedford Mass.). Each cell type was grown in the corresponding labeling media, prepared as described above, supplemented with 2 mM L-glutamine (Gibco), and 10% dialyzed fetal bovine serum (Sigma) plus antibiotics (Gibco), in a humidified atmosphere with 5% CO2 in air. Cells were grown for at least six cell divisions in labeling media.

Biochemical Purification with Lenalidomide-Derivative Beads

Separate cultures of K562 cells SILAC labeled either with L-arginine and L-lysine (light) or L-arginine-13C6 and L-lysine-13C6-15N2 (heavy) were lysed in ice-chilled ModRIPA buffer containing 1% NP-40, 0.1% Na deoxycholate, 150 mM NaCl, 1 mM EDTA, 50 mM Tris, pH 7.5, and protease inhibitors (Complete™ tablets, RocheApplied Science, Indianapolis, Ind.). Lysates were vortexed intermittently while chilled on ice for 10 min and clarified by spinning at 14,000×g. Protein concentrations of light and heavy lysates were estimated with the Protein Assay Dye Reagent Concentrate (Biorad, Hercules Calif.) and equalized. The protein concentrations of lysates varied between 1.7 to 2.2 mg/mL, affinity enrichments were performed in lysate volumes of 1.4 mL in a 1.5 mL microcentrifuge tube.

Lenalidomide (in DMSO) at 100-fold excess over the amount of lenalidomide-derivative on beads was added to 2 mg of light lysate. An equal volume of DMSO was then added to 2 mg of heavy lysate as a control and pre-incubated for 30 minutes. Thirty microliters of a 50% slurry in phosphate buffered saline (PBS) of lenalidomide-derivative bead was added to both light and heavy lysates.

Affinity enrichments were incubated overnight (approx. 16 hrs) on an end-over-end rotator at 4° C. Following incubation, the tubes were spun at 1000×g on a benchtop centrifuge to pellet the beads. The supernatant was aspirated, taking care to avoid disturbing the beads. Each tube in a set was washed with ModRIPA buffer twice to remove excess soluble small molecule competitor. Beads from the two tubes were then be combined for an extra washing step in ModRIPA. After the third and final wash, beads were collected by spinning at 1000×g and the wash aspirated leaving approximately 20 μL of buffer in the tube.

The experiment was done in process replicate in which the labels were swapped, with lenalidomide being pre-incubated in the heavy and DMSO in the light.

1D-SDS-PAGE and MS Analysis for Lenalidomide-Protein Interaction Studies.

Proteins enriched in SILAC affinity pull-downs were reduced and alkylated, on bead, in 2 mM DTT and 10 mM iodoacetamide respectively. One part LDS buffer (Invitrogen) was added to three parts sample (including beads) and tubes heated to 70° C. for 10 minutes. Proteins were resolved on a 4-12% gradient 1.5 mm thick Bis-Tris gel with MES running buffer (Nupage, Invitrogen) and Coomassie stained (Simply Blue, Invitrogen). Gel lanes were excised into six pieces and then further cut into 1.5 mm cubes. The gel pieces were further destained in a solution containing 50% EtOH and 50% 50 mM ammonium bicarbonate, then dehydrated in 100% EtOH before addition of sufficient trypsin (12.5 ng/μL) to swell the gel pieces completely. An additional 100 μL of 50 mM ammonium bicarbonate was added before incubating at 37° C. overnight on a thermomixer (Eppendorf). Enzymatic digestion was stopped by the addition of 100 μL of 1% TFA to tubes. A second extraction with 300 μL of 0.1% TFA was combined with the first extract and the peptides from each gel slice cleaned up on C18 StageTips. (Rappsilber et al., Nature protocols 2, 1896 (2007)) Peptides were eluted in 50 μL of 80% acetonitrile/0.1% TFA and dried down in an evaporative centrifuge to remove organic solvents. The peptides were then resuspended by vortexing in 7 μL of 0.1% TFA and analyzed by nanoflow-LCMS with an Agilent 1100 with autosampler and a LTQ Orbitrap. Peptides were resolved on a 10 cm column, made in-house by packing a self-pulled 75 μm I.D. capillary, 15 μm tip (P-2000 laser based puller, Sutter Instruments) column with 3 μm Reprosil-C18-AQ beads (Dr. Maisch GmbH, Ammerbuch-Entringen, Germany) with an analytical flowrate of 200 nL/min and a 58 min linear gradient (˜0.57% B/min) from 0.1% formic acid in water to 0.1% formic acid/90% acetonitrile. The run time was 108 min for a single sample, including sample loading and column reconditioning. An MS method was used a with a master Orbitrap full scan (60,000 resolution) and data dependent LTQ MS/MS scans for the top five precursors (excluding z=1) from the Orbitrap scan. Each cycle was approximately 2 secs long.

Identification and Quantification of Proteins for Lenalidomide-Protein Interaction Studies

All mass spectra were analyzed with MaxQuant software version 1.1.1.36⁴. using a human IPI database v3.68. MS/MS searches for the proteome data sets were performed with the following parameters: Oxidation of methionine and protein N-terminal acetylation as variable modifications; carbamidomethylation as fixed modification. Trypsin/P was selected as the digestion enzyme, and a maximum of 3 labeled amino acids and 2 missed cleavages per peptide were allowed. The mass tolerance for precursor ions was set to 20 p.p.m. for the first search (used for nonlinear mass re-calibration) and 6 p.p.m. for the main search. Fragment ion mass tolerance was set to 20 p.p.m. For identification a maximum FDR of 1% was applied separately on protein, peptide and PTM-site level. 2 or more unique/razor peptides were required for protein identification and a ratio count of 2 or more for protein quantification per replicate measurement.

CRBN-Protein Interaction Studies

MMS1 cells stably expressing FLAG- or HA-tagged CRBN were grown for 2 weeks (˜6 cell doublings) in RPMI depleted of L-arginine and L-lysine (Caisson Labs Inc.) and supplemented with 10% dialyzed FBS (Sigma) and amino acids as described above to generate light-, medium- and heavy-labeled cells. FLAG-CRBN expressing cells were cultured in light media, HA-CRBN expressing cells were grown in medium and heavy media. On day 14, HA-CRBN expressing cells grown in medium media were treated with DMSO and HA-CRBN cells grown in heavy media with 1 μM lenalidomide for 6 hours. For a second replicate labels were swapped such that HA-tagged CRBN expressing cells grown in medium media were treated with lenalidomide and cells grown in heavy media treated with DMSO. Cells were lysed in IP lysis buffer (Pierce) containing protease and phosphatase inhibitor cocktail (Pierce). For immunoprecipitation of HA-tagged proteins, 1000 μg protein was incubated together with HA-Tag Rabbit mAb Sepharose (C29F4) Bead Conjugate (Cell Signaling) over night at 4° C. in the presence of 1 μM lenalidomide or DMSO. Lysates of FLAG-CRBN expressing cells served as negative control to exclude non-specific binding to the anti-HA sepharose conjugates used for immunoprecipitation. For a schematic presentation of the experiment see FIG. 4.

1D-SDS-PAGE and MS Analysis for CRBN-Protein Interaction Studies.

The beads from immunopurification samples were washed once with IP lysis buffer (Pierce), then the three different lysates of each replicate combined, washed again and reduced and alkylated, on bead, in 2 mM DTT and 10 mM iodoacetamide respectively. One part LDS buffer (Invitrogen) was added to three parts sample (including beads) and tubes heated to 70° C. for 10 minutes. Proteins were resolved on a 4-12% gradient 1.5 mm thick Bis-Tris gel with MES running buffer: 50 mM (2-[N-morpholino]ethanesulfonic acid); 50 mM Tris base; 1 mM EDTA; 1% (w/v) SDS (Nupage, Invitrogen) and Coomassie stained (Simply Blue, Invitrogen). Gel lanes were excised into nine pieces and then further cut into 1.5 mm cubes. The gel pieces were further destained in a solution containing 50% EtOH and 50% 50 mM ammonium bicarbonate, then dehydrated in 100% EtOH before addition of sufficient trypsin (12.5 ng/μL) to swell the gel pieces completely. An additional 100 μL of 50 mM ammonium bicarbonate was added before incubating at 37° C. overnight on a thermomixer (Eppendorf). Enzymatic digestion was stopped by the addition of 100 μL, of 1% trifluoracetic acid (TFA) to tubes. A second extraction with 300 μL of 0.1% TFA was combined with the first extract and the peptides from each gel slice cleaned up on C18 StageTips (Rappsilber et al., Nature protocols 2, 1896 (2007)). Peptides were eluted in 50 μL of 80% acetonitrile/0.1% TFA and dried down in an evaporative centrifuge to remove organic solvents. The peptides were then reconstituted with 3% ACN in 0.1% formic acid. Reconstituted peptides were separated on an online nanoflow EASY-nLC 1000 UHPLC system (Thermo Fisher Scientific) and analyzed on a benchtop Orbitrap Q Exactive mass spectrometer (Thermo Fisher Scientific). The peptide samples were injected onto a capillary column (Picofrit with 10 μm tip opening/75 μm diameter, New Objective, PF360-75-10-N-5) packed in-house with 20 cm C18 silica material (1.9 μm ReproSil-Pur C18-AQ medium, Dr. Maisch GmbH, r119.aq). The UHPLC setup was connected with a custom-fit microadapting tee (360 μm, IDEX Health & Science, UH-753), and capillary columns were heated to 50° C. in column heater sleeves (Phoenix-ST) to reduce backpressure during UHPLC separation. Injected peptides were separated at a flow rate of 200 nL/min with a linear 80 min gradient from 100% solvent A (3% acetonitrile, 0.1% formic acid) to 30% solvent B (90% acetonitrile, 0.1% formic acid), followed by a linear 6 min gradient from 30% solvent B to 90% solvent B. Each sample was run for 150 min, including sample loading and column equilibration times. Data-dependent acquisition was obtained using Xcalibur 2.2 software in positive ion mode at a spray voltage of 2.00 kV. MS1 Spectra were measured with a resolution of 70,000, an AGC target of 3e6 and a mass range from 300 to 1800 m/z. Up to 12 MS2 spectra per duty cycle were triggered at a resolution of 17,500, an AGC target of 5e4, an isolation window of 2.5 m/z and a normalized collision energy of 25. Peptides that triggered MS2 scans were dynamically excluded from further MS2 scans for 20 s.

Identification and Quantification of Proteins for CRBN-Protein Interaction Studies.

All mass spectra were analyzed with MaxQuant software version 1.3.0.5. (J. Cox et al., Journal of proteome research 10, 1794 (Apr. 1, 2011)) using a human Uniprot database. MS/MS searches for the proteome data sets were performed with the following parameters: Oxidation of methionine and protein N-terminal acetylation as variable modifications; carbamidomethylation as fixed modification. Trypsin/P was selected as the digestion enzyme, and a maximum of 3 labeled amino acids and 2 missed cleavages per peptide were allowed. The mass tolerance for precursor ions was set to 20 p.p.m. for the first search (used for nonlinear mass re-calibration) and 6 p.p.m. for the main search. Fragment ion mass tolerance was set to 20 p.p.m. For identification a maximum FDR of 1% was applied separately on protein, peptide and PTM-site level. 2 or more unique/razor peptides were required for protein identification and a ratio count of 2 or more for protein quantification per replicate measurement. To assign interacting proteins the Limma package was used in the R environment to calculate moderated t-test p, as described previously (9).

Cell Culture and Treatment for K-ε-GG and Proteome Profiling

MM1S cells were cultured for 2 weeks (˜6 cell doublings) in RPMI depleted of L-arginine and L-lysine (Caisson Labs Inc.) and supplemented with 10% dialyzed FBS (Sigma) and amino acids as described above to generate light-, medium- and heavy-labeled cells. Media was exchanged every 3rd day. On day 14 cells were treated for 12 hours with 1 μM lenalidomide, 20 μM thalidomide or DMSO. For each of the three replicates SILAC labels were flipped:

SILAC labelling Light Medium Heavy Replicate 1 DMSO Thal 20 uM Len 1 uM Replicate 2 Len 1 uM DMSO Thal 20 uM Replicate 3 Thal 20 uM Len 1 uM DMSO For the last 3 hours cells determined for K-ε-GG profiling were treated with 5 μM MG132 together with lenalidomide, thalidomide or DMSO. K-ε-GG profiling was later performed for all 3 replicates and proteome profiling for replicate 1 and 2.

Cell Lysis and Trypsin Digestion for K-ε-GG and Proteome Profiling

SILAC-labeled cell pellets were lysed in 8 M urea, 50 mM Tris-HCl, pH 7.5, 150 mM NaCl, 1 mM EDTA, 2 ug/ml aprotinin (Sigma-Aldrich), 10 ug/ml leupeptin (Roche Applied Science), 1 mM phenylmethylsulfonyl fluoride (PMSF), 50 uM PR-619, and 1 mM chloroacetamide at 4 C. Following lysis, samples were centrifuged at 20,000×g for 15 minutes at 4 C to remove insoluble material. Protein concentrations were determined using a bicincohoninic acid (BCA) protein assay (Pierce) and samples were mixed equitably at 10 mg per SILAC state. Proteins were reduced with 5 mM dithiothreitol for 45 minutes at room temperature (RT) and subsequently carbamidomethylated with 10 mM iodoacetamide for 30 min at RT in the dark. Samples were diluted to 2 M urea with 50 mM Tris-HCl, pH 7.5, and digested with sequencing grade trypsin (Promega) at 25 C o/n using an enzyme to substrate ratio of 1:50. Digested samples were acidified to 1% formic acid (FA) (Sigma-Aldrich).

Tryptic peptides were desalted on 500-mg tC18 Sep-Pak SPE cartridges (Waters). Cartridges were conditioned with 5 ml of 100% acetonitrile (MeCN), 5 ml of 50% MeCN/0.1% FA, and four times with 5 ml of 0.1% trifluoroacetic acid (TFA). Up to 15 mg of sample was loaded onto a single cartridge, and subsequently washed 3× with 5 ml of 0.1% TFA. Samples were eluted from cartridges by washing 2× with 3 ml of 50% MeCN/0.1% FA. Desalted samples were dried overnight in a Savant SC210A SpeedVac concentrator (Thermo Scientific).

Basic pH Reverse Phase (bRP) Fractionation

Offline bRP fractionation was completed using a custom-manufactured Zorbax 300 Extend-C18 column (9.4×250 mm, 300 Å, 5 um, Agilent) on an Agilent 1100 series HPLC system. Approximately 15 mg of peptide sample was resuspended in 1.8 ml of basic RP solvent A (2% MeCN, 5 mM ammonium formate, pH 10), separated into 2 HPLC vials and injected with Solvent A at flow rate of 3 ml/min. A 64-min method was used for fractionation. The gradient was composed of an initial increase to 8% Solvent B (1.1% B/min) (90% MeCN, 5 mM ammonium formate), followed by a 38-minute linear phase (0.5% B/min) where the amount of solvent B was increased form 8% to 27% and ramp phases where the Solvent B amount was increased from 31% (1% B/min) to 39% (0.5% B/min), and finally to 60% (3% B/min). A total of 96 2 ml fractions were collected every 0.66 min at a flow rate of 3 ml/min. For the proteome profiling, 5% of each fraction was pooled into 22 fractions. For ubiquitination profiling, 95% of each fraction was pooled into 8 fractions using a concatenated pooling strategy. Pooled samples were dried using a SpeedVac concentrator.

K-ε-GG Enrichment

The anti-K-ε-GG antibody was obtained from the PTMScan® ubiquitin remnant motif (K-ε-GG) kit (Cell Signaling Technology). Prior to enrichment, the antibody was covalently coupled to Protein A agarose beads by chemical cross-linking with DMP. For cross-linking, the antibody bound beads were first washed 3× with 1 ml of 100 mM sodium borate, pH 9 and then incubated in 1 ml of 20 mM dimethyl pimelimidate (DMP) for 30 minutes with rotation at RT. The reaction was stopped by washing beads 2× with 1 ml of 200 mM ethanolamine, pH 8 followed by incubation for 2 hours at 4 C with rotation. Antibody-bound beads were washed three times in 1.5 ml of ice cold immunoprecipitation (IAP) buffer (50 mM MOPS, pH 7.2, 10 mM sodium phosphate, 50 mM NaCl), resuspended in IAP buffer, and stored at 4 C.

For K-ε-GG enrichment, bRP fractions were reconstituted in 1.5 ml of IAP buffer and each fraction was incubated with 32 ug of cross-linked anti-K-ε-GG antibody for 1 hour, at 4 C, while rotating. Following incubation, samples were spun down at 2000×g and the supernatant was removed. Antibody-bound beads were washed 4× with 1.5 ml of ice cold PBS and peptides were then eluted from the beads with 2×50 ul of 0.15% TFA. Eluted peptides were desalted using C18 StageTips. Each StageTip was packed with two plugs of C18 material (Empore™ C18 Extraction Disk; 3M) and then conditioned with 100 ul of MeOH, 100 ul of 50% MeCN/0.1% FA, and 2× with 100 ul of 0.1% FA. K-ε-GG peptides were loaded onto the condition StageTips, washed 2× with 100 ul of 0.1% FA, eluted with 50 ul of 50% MeCN/0.1% FA, and dried to completeness.

LC-MS/MS Analysis

K-ε-GG and global proteome fractions were reconstituted in 8 ul and 20 ul of 3% MeCN/1% FA, respectively, and analyzed by nanoflow-UPLC-HCD-MS/MS using Q Exactive mass spectrometer (Thermo Fishes Scientific) coupled on-line to a Proxeon Easy-nLC 1000 system. 4 ul and 1 ul of K-ε-GG and global proteome samples was injected, respectively, for each analysis. Samples were injected onto a microcapillary column (360 um OD×75 um ID) packed with 24 cm of ReproSil-Pul C18-AQ 1.9 um beads (Dr. Maisch GmbH) that was equipped with an integrated electrospray emitter tip (10 um). For online analyses, the column was heated to 50 C using a 20 cm column heater (Phoenix S&T). For LC separation, solvent A was 0.1% FA/3% MeCN and solvent B was 90% MeCN/0.1% FA. Peptides were eluted on the mass spectrometer at a flow rate of 200 nl/min using a gradient consisting of a linear phase at 0.3% B/min, followed by a ramp to 60% B (10% B/min). The total analysis time for each sample was 150 minutes. The Q Exactive instrument was operated in the data-dependent mode acquiring HCD MS/MS scans (R=17,500) after each MS1 scan (R=70,000) on the 12 top most abundant ions using an MS1 ion target of 3×10⁶ ions and an MS2 target of 5×10⁴ ions. The maximum ion time utilized for the MS/MS scans was 120 ms; the HCD-normalized collision energy was set to 25; the dynamic exclusion time was set to 20 s, and the peptide match and isotope exclusion functions were enabled.

K-ε-GG and Proteome MS Data Analysis

MS data was analyzed with the MaxQuant software version 1.3.0.5 and searched against the human Uniprot database that contained 248 common laboratory contaminants was provided by the MaxQuant software package. The search parameters were as follows: enzyme specificity was set to trypsin, maximum number of mixed cleavages to 2, precursor mass tolerance was at 20 ppm for the first search (used for nonlinear mass re-calibration), and set to 6 ppm for the main search. Oxidized methionines and N-terminal protein acetylation were searched as variable modifications, with carbamidomethylation of cysteines set to fixed modification. For searching K-ε-GG data files, Gly-Gly addition to lysines was also searched as a variable modification. The minimum peptide length was set to 6, and false discovery rate for peptide, protein, and side identification was set to 1%. The filter labeled amino acids and peptide quantification functions were enabled. For proteome data, proteins were considered in the dataset if they were identified by 2 or more razor/unique peptides and quantified by 3 or more ratio counts in bot biological replicates. For the K-ε-GG data, K-ε-GG sites were considered if they were confidently localized (>0.75) and quantified in all three biological replicates.

Cell Lines and Primary Cells

MM15, NCI-H929, U266, Namalwa, Jurakat, K562, KIEL and 293T cells were obtained from American Type Culture Collection. Cells were cultured in RPMI 1640 (Mediatech) or DMEM (Mediatech) supplemented with 10-20% heat-inactivated fetal bovine serum (Omega Scientific) and 1% penicillin, streptomycin, and L-glutamine (Mediatech). Cells were grown at 37° C. in a humidified incubator under 5% CO₂.

Primary T cells were obtained from healthy donors under an Institutional Review Board approved protocol at the Dana-Farber Cancer Institute. PBMCs were isolated using Ficoll (Ficoll-Paque PLUS, GE Healthcare) according to the protocol. After positive selection with CD3+ MACS beads (Miltenyi), T cells were cultured in RPMI with 10% human Serum (Sigma) and 100 U/ml recombinant IL-2 (Miltenyi). For stimulation, tissue culture plates were pre-coated with 2.5 μg/ml CD3 (OKT3, Biolegend) and CD28 (CD28.2, Pharmingen).

Antibodies

The following antibodies were used: HA-HRP (Miltenyi, GG8-1F3.3), Flag-HRP (M2, Sigma Aldrich), Actin-HRP (Abcam), rabbit IKZF3 (Imginex), IKZF1 (H-100, Santa Cruz), FK2-HRP (Enzo Lifescience), DDB1 (Abcam), and p27 (Cell Signaling).

Virus Constructs

For cDNA over-expression, the RSF91 retrovirus backbone (kind gift of Prof. Dr. Christopher Baum of Hanover Medical School) was used. For certain constructs GFP was replaced by GFP-T2A-Puro or dTomato. The Gateway Vector Conversion System (Invitrogen) was used to converted RSF91 to a Gateway Destination vector. Entry clones were obtained from the Broad Institute Orfeome collection and cloned into RSF91-Gateway with LR clonase enzyme mix II (Invitrogen). IKZF4 cDNA was obtained from GeneCopeia. The CRBN YWAA mutant, IKZF3 and IKZF4 mutants, IKZF2 Isoform 1 were cloned by PCR using overlapping primers containing the respective mutations.

ORF Origin Clone IKZF1 Broad Institute ORF016074.1_s300c1 IKZF2 Broad Institute ORF018485.1_s300c1 IZKF3 Broad Institute ORF000952.1_s304c1 IKZF4 GeneCopoeia # GC-Z2828 IZKF5 Broad Institute ORF004130.1_s300c1 RAB28 Broad Institute ORF011035.1_s304c1 IRF4 Broad Institute ORF002494.1_s304c1 HOXA9 Broad Institute ORF016570.1_s300c1 CRBN Broad Institute ORF007943.1_s300c1 Lentivrial vectors expressing shRNAs were obtained from the RNAi consortium (TRC) of the Broad Institute:

shRNA Clone Name Target sequence Luciferase#1 TRCN0000072254 ATGTTTACTACACTCGGATAT Luciferase#2 TRCN0000072243 CTTCGAAATGTCCGTTCGGTT CRBN#1 TRCN0000141562 CGCTGGCTGTATTCCTTATAT CRBN#2 TRCN0000144360 CAGGATAGTAAAGAAGCCAAA CRBN#3 TRCN0000139091 CTTAACGCGATCTGCTCTGTT IKZF1#1 TRCN0000236419 CCGCTTCCACATGAGCTAAAG IKZF1#2 TRCN0000236420 GCATTTGGAAACGGGAATAAA IKZF1#3 TRCN0000244221 GTGATATCTGTGGGATCATTT IKZF3#1 TRCN0000236419 CCGCTTCCACATGAGCTAAAG IKZF3#2 TRCN0000236420 GCATTTGGAAACGGGAATAAA IKZF3#3 TRCN0000244221 GTGATATCTGTGGGATCATTT

The luciferase reporter plasmid CMV-IRES-RenillaLUC-IRES-Gateway-FireflyLUC (11) was a kind gift from William G. Kaelin (Dana-Farber Cancer Institute). Cloning of cDNAs was performed using Gateway LR reaction (invitrogen). 24 hours after transfection of 40 ng reporter plasmid in 10×e4 293T cells, the media was changed to media containing lenalidomide or the vehicle control. After an additional 24 hours, dual luciferase assays were performed using the Dual-Glo Luciferase Assay System (Promega) according to the manufacturer's protocol.

Transfections, Virus Production and Infections

Retro- or lentiviral vectors were transfected using TRANS-LTI (Mirrus) into 293T cells together with packaging plasmid (retrogagpol or pSPAX2) and envelope plasmids expressing VSV-G. The media was changed after 12 hours, and the viral supernatant was collected 36 hours and 48 hours after transfection.

For viral infection, cells were seeded in high density and supplemented with Polybrene (Sigma) at concentrations of 1 to 2 μg/ml. Primary T cells were stimulated on plates pre-coated with anti-C3/CD28 for 48 h before lentiviral transduction. Puromycin selection was started 1 day after transduction at concentrations between 0.5 and 2 μg/ml.

Quantitative RT-PCR

Gene expression was measured by reverse transcription quantitative PCR. (RQ-PCR). cDNA was synthesized using the cDNA synthesis Kit for Multimacs (Miltenyi) according to the manufacturer's protocol, and used 1 ul of the product per RQ-PCR reaction in a 384-well plate. The following primer-probe sets from fife Technologies were used: GAPDH ( ), IKZF1 ( ), IKZF3 ( ), CRBN (Hs00372271_m1), IL-2 ( ). Analysis was performed on a 7900HT Fast Real-Time PCR System (Applied Biosystems). Expression levels were calculated using the ΔΔCT method.

Western Blot

Protein lysates were run on Tris-HCl, 1 mm Criterion™ Precast gels (Bio-Rad) at a constant voltage. Proteins were transferred onto Imobilon-P transfer membranes (Millipore) at a constant amperage. Before staining, blots were blocked in 5% BSA in TBST for 30 minutes.

Immunoprecipitation

For immunoprecipitation of HA-tagged proteins, the HA-protein Isolation Kit from Miltenyi was used according to the manufacturer's protocol using an MultiMACS M96 Separator (Miltenyi). Proteins tagged with the FLAG peptide were immunoprecipitated using anti-FLAG M2 Affinity Gel (Sigma-Aldrich) according to the manufacturer's protocol. 500 to 1000 μg protein was incubated together with the specific bead-bound antibody overnight at 4° C. The samples were washed 4 times with RIPA buffer or IP lysis buffer (Pierce) and protein was eluted from the affinity gel or Multimacs columns with 98° C. laemmli buffer (Bio-Rad).

In Vivo Ubiquitination

MM1S or 293T cells expressing tagged IKZF1 or IKZF3 were treated with the respective concentrations of lenalidomide and/or epoxomicin for 1.5 hours. Cells were then washed twice with ice-cold PBS and lysed under denaturing conditions using 2% SDS-containing lysis buffer and boiled for 10 minutes. SDS was diluted with addition of 10× Ip lysis buffer (Pierce), incubated at 4° C. for 30 minutes prior addition of IP antibodies. Immunoprecipitation was performed over night and then washed 4× with 1 ml RIPA buffer. Proteins were eluted from the beads by addition of Laemmli buffer and incubation at 95° C. for 5 minutes. The supernatant was then loaded on a gel and analyzed by Western Blot.

In Vitro Ubiquitination

293T cells were co-transfected with HA-IKZF3 and FLAG-CRBN. After 48 hours cells were treated with DMSO or 1 μM lenalidomide for 20 minutes, lysed in IP lysis buffer (Pierce) and immunoprecipitation was performed overnight with anti-FLAG M2 sepharose beads (Sigma) to obtain CRBN together with CRBN-bound IKZF3. The beads were washed 3× with IP lysis buffer, 1× ubiquitination buffer (Boston Biochem) and eluted with 250 μg/ml FLAG peptide (Sigma) for 30 min at 4° C. The CRBN-IKZF3 complex was incubated for 90 min at 30° C. in ubiquitination reaction mixture containing 200 nM E1, 500 nM E2 (UbcH5a and UbcH5b), 20 μg ubiquitin, 1 μM ubiquitin aldehyde, 1× ubiquitin reaction buffer, 1× Energy Restoration System (all Boston Biochem), and 100 nM MG101 in a total volume of 75 μl. Negative controls did not include E1 and E2 enzymes. 20 μl of the reaction was denatured by adding 5×SDS containing loading buffer (Boston Biochem) and boiling at 95° C. for 5 minutes, separated by SDS-PAGE and transferred to a PVDF membrane in order to detect HA-IKZF3 and its ubiquitinated forms with an HA specific antibody. The remaining 55 μl reaction mix were denatured by adding SDS to a final concentration of 1% and boiling for 10 minutes. 500 μl IP lysis buffer was added for 30 minutes before adding anti-HA magnetic beads (Miltenyi) for 1 hour. After purification on Multimacs columns (Miltenyi) eluates were separated by SDS-PAGE, transferred to a PVDF membrane and stained with anti-ubiquitin antibodies (FK2).

Flow Cytometry

Flow cytometry was performed on a FACS Canto II (BD Bioscience) using PE channel for detection of dTomato-, and FITC for GFP-expressing cells. DAPI staining was performed to exclude dead cells.

For investigating shRNA effects on proliferation 50,000 cells were infected in a 96-well plate with 50 μl lentivirus containing medium in the presence of polybrene. Media was changed after 24 hours. The number of infected cells was determined on day 2 when GFP was fully expressed in all infected cells. The number of viable GFP positive cells on day 2 was set to 100% to normalize for transduction efficiency and every consecutive assessment was calculated in relation to day 2.

To investigate the effect of IKZF3 over-expression on lenalidomide sensitivity, MM1S were separately infected with an empty backbone expressing dTomato or an IKZF3 and GFP expressing vector. After two days cells were washed, combined in a 96-well plate and analyzed by flow cytometry for the relative number of GFP and Tomato expressing cells before start of lenalidomide treatment. Media was changed every 3^(rd) day containing the drug. Every experiment was performed in triplicate.

Viability

For assessing the effects of lenalidomide on cell growth cells were plated in a 96-well plate and treated with lenalidomide. On the respective days, total cellular ATP content was assessed using CellTiter-Glo® Luminescent Cell Viability Assay (Promega) according to the protocol. Luminescence was assessed by a multimode detector DTX880 (Beckman Coulter).

The results described in Example 8 were carried out using the following methods and materials.

Reagents

Lenalidomide (Toronto Research Chemicals and Selleck Chemicals), Thalidomide (Milipore), Pomalidomide (Selleck Chemicals), MG-132 (Selleck Chemicals), CC-122 (Celgene), PR619 (Lifesensors) and MLN4924 (Active Biochem) were dissolved in DMSO at 10 to 100 mM and stored at −20° C. for up to 6 months. For cell culture experiments drugs were diluted at least by 1:1000 so that the final DMSO concentration was 0.1% or lower.

Cell Lines

KG-1, Ba/F3, K562, MM1S, Jurkat, and 293T cells were obtained from American Type Culture Collection (ATCC). Cells were cultured in RPMI 1640 (Mediatech) or DMEM (Mediatech) supplemented with 10-20% heat-inactivated fetal bovine serum (FBS)(Omega Scientific) and 1% penicillin, streptomycin, and L-glutamine (Mediatech). Cells were grown at 37° C. in a humidified incubator under 5% CO₂. Ba/F3 cells were cultured in the presence of 10 ng/ml murine IL-3 (Miltenyi) and MDS-L cells were cultured with 10 ng/ml human GM-CSF. 293T cells were transfected using TransIT-LT1 (Mirius Bio) according to the manufacturer's protocol.

Cell Culture and Treatment for K-ε-GG and Proteome Profiling

KG-1 cells were cultured for 2 weeks (˜6 cell doublings) in RPMI depleted of L-arginine and L-lysine (Caisson Labs Inc.) and supplemented with 10% dialyzed FBS (Sigma) and L-arginine (Arg0) and L-lysine (Lys0) (light), ¹³C₆ ¹⁴N₄-L-arginine (Arg6) and 4,4,5,5-D₄-L-lysine (Lys4) (medium) or ¹³C₆ ¹⁵N₄-L-arginine (Arg10) and ¹³C₆ ¹⁵N₂-L-Lysine (Lys8) (heavy) to generate light-, medium- and heavy-labeled cells. Media was exchanged every 3^(rd) day. On day 14 cells were treated with 1 μM lenalidomide, 10 μM lenalidomide or DMSO for 4 hours for ubiquitination profiling and 24 hours for protein level assessment. Experiments were performed in two biological replicates with flipped SILAC labeling: Relicate 1: DMSO/light, lenalidomide 1 μM/medium; lenalidomide 10 μM/heavy; replicate 2: lenalidomide 10 μM/light, DMSO/medium; lenalidomide 1 μM/heavy.

SILAC Based K-ε-GG and Proteome Profiling of KG-1 Cells

Cell lysis and trypsin digestion, basic pH reversed phase fractionation, K-ε-GG enrichment, and LC-MS/MS analysis for KG-1 cells were performed as recently described (Science 343, 301-305, (2014)). For this work, 10 mg of protein was input per SILAC state for the ubiquitin workflow. For proteome profiling, 1.5 mg of protein was input per SILAC state and samples were fractionated by bRP using a 4.6 mm×250 mm column (Agilent, 3.5 urn bead size) using the method previously described (Nature methods 10, 634-637, (2013)).

For data analysis, normalized SILAC ratios for the 2 biological replicates were filtered to retain only those deemed reproducible. Reproducibility was based on replicates being confined within the 95% limits of agreement of a Bland-Altman plot. In the Bland-Altman plot, differences of the replicates are plotted against the average values and the limits of agreement correspond to the prediction confidence interval for a regression line with unit slope. Reproducible replicates were then subjected to a moderated T-test to assess statistical significance. This statistic is similar to the ordinary t-statistic, with the exception that the standard errors are calculated using an empirical Bayes method utilizing information across all proteins, thereby making inference about each individual protein more robust. The nominal p-values arising from the moderated t-statistic are corrected for multiple testing by controlling the false discovery rate (FDR). Proteins with an FDR adjusted p-value of less than 0.05 were deemed to be reproducibly regulated. Figures containing scatter plots of SILAC data show all points regardless of the reproducibility measure. Statistical significance was assessed using only reproducible data points.

Plasmids and Virus Constructs

The following cDNAs were cloned in the RSF91 retrovirus backbone (kind gift of Christopher Baum, Hanover Medical School) or EF1a-IRES-GFP lentiviral backbone: CSNK1A1 Isoform 2 (ccsbBroadEN_06055), CSNK1E (ccsbBroadEN_00379), murine CRBN Isoform 2 (Thermo Scientific), and human CRBN Isoform 2 (ccsbBroadEn_08244). For certain experiments GFP was replaced by dTomato for competition experiments or GFP-T2A-Puro to allow for drug selection of positively transduced cells. Chimeric cDNAs and point mutations were cloned with overlapping PCR primers. Lentivirus was concentrated by ultracentrifugation for transduction of primary cells.

Lentiviral vectors (TRC005 backbone) expressing shRNAs targeting luciferase (TRCN0000072254: ATGTTTACTACACTCGGATAT) and CSNK1A1 (#1: TRCN0000342505, CATCTATTTGGCGATCAACAT; #2: TRCN0000342507, GCAGAATTTGCGATGTACTTA) were obtained from The RNAi Consortium (TRC) of the Broad Institute. For certain experiments, the puromycin resistance gene was replaced by GFP.

The luciferase reporter plasmid CMV-IRES-RenillaLUC-IRES-Gateway-FireflyLU was a kind gift from William G. Kaelin (Dana-Farber Cancer Institute). Cloning of cDNAs was performed using Gateway LR reaction (Invitrogen).

CRISPR mediated genetic deletion was performed with the sgRNA-CAS9-T2A-Puro plasmid.²⁹ A CRBN exon 1-specific guide RNA was cloned in the BsmBI site.

1×10⁵ 293 T cells were transfected in a 12-well with 1 μg plasmid using TransLTI (Mirrus). After 24 hours transfected cells were selected with 2 μg/ml puromycin for 4 days. Then 293T cells were diluted to single cell and plated in 96-well. Colonies were tested by western blot and sanger sequencing of the endogenous CRBN exon1 locus for inactivating biallelic out-of-frame mutations.

Western Blot and Antibodies

Protein lysates were run on Tris-HCl, 1 mm Criterion™ Precast gels (Bio-Rad) or NuPAGE Bis-Tris gels (Novex) gels at a constant voltage. Proteins were transferred onto Immobilon-P transfer membranes (Millipore) at a constant amperage. Before staining with primary antibodies, blots were blocked in 5% non-fat dry milk (Santa Cruz) or BSA in TBST for 30 minutes.

For protein detection primary antibodies detecting CK1α (C-19, Santa Cruz or Abcam ab108296), HA (HRP-conjugate, Miltenyi, GG8-1F3.3), FLAG (M2, HRP-conjugate Sigma Aldrich), ubiquitin (FK2, HRP-conjugate Enzo Life Sciences), Actin (HRP-conjugate, Abcam), and GAPDH (Santa Cruz sc-47724) were used. Secondary antibodies were HRP conjugated Bovine anti-Goat (Jackson ImmunoResearch) and HRP conjugated donkey anti-rabbit (GE Healthcare). Supersignal chemi-luminescent substrate was used for detection. For re-probing, blots were stripped in Restore Western Blot Stripping Buffer (Thermo Scientific), activated in methanol, and re-blocked.

Flow Cytometry

Flow cytometry was performed on a FACS Canto II (BD Bioscience) using the PE and FITC channels for the detection of dTomato and GFP, respectively. DAPI staining was performed to exclude dead cells. A High-Throughput Sampler (BD) was used for some experiments.

Quantitative RT-PCR

Gene expression was measured by reverse transcription quantitative PCR (RQ-PCR). For RNA isolation and reverse transcription a cDNA Synthesis Kit for MultiMacs (Miltenyi) was used according to the manufacturer's protocol. The following primer-probe sets from Life Technologies were used with TaqMan Gene Expression Master Mix (Life Technologies): human GAPDH (402869), human CSNK1A1 (Hs00793391_m1), murine GAPDH (Mm99999915_g1), murine p21 (Mm04205640_g1). Analysis was performed on a 7900HT Fast Real-Time PCR System (Applied Biosystems) in a 384-well plate. Relative expression levels were calculated using the ΔΔCT method.

Immunoprecipitation of FLAG-CRBN

3×10⁶ 293 T cells were plated in a 10 cm dish and transfected with 10 μg FLAG-hCRBN or empty vector. Cells were treated with DMSO or 1 μM lenalidomide and 10 μM MG132 for 3 hours. Cells were lysed in Pierce IP Lysis Buffer and lysates were cleared by centrifugation. FLAG-CRBN was immunoprecipitated overnight using anti-FLAG M2 Affinity Gel (Sigma-Aldrich) in the presence of 10 μM MG132 and DMSO or 1 μM lenalidomide. The beads were washed 3 times with IP lysis buffer (Pierce) and protein was eluted from the affinity gel with 250 μg/ml FLAG peptide (Sigma) after incubation for 30 min at 4° C. Protein lysates were then analyzed as described above.

In Vivo Ubiquitination

For in vivo ubiquitination analysis 300,000 293T cells were plated in a 6-well. The next day, cells were transfected with 100 ng FLAG-CRBN and 300 ng HA-CK1α using TransLTI (Mirus). After 48 hours, cells were treated with lenalidomide or DMSO and 10 μM MG132 for 4 hours. Cells were then washed twice with ice-cold PBS and lysed under denaturing conditions using 1% SDS-containing lysis buffer and boiled for 10 minutes at 95° C. The SDS was diluted with the addition of 9 volumes of IP lysis buffer (Pierce) followed by incubation at 4° C. for 30 minutes. Lysates were cleared from debris by centrifugation and incubated with anti-HA microbeads (Miltenyi) in the presence of lenalidomide or DMSO, 10 μM MG132, and 50 μM PR-619 for 1 hour. Samples were applied to columns on a MultiMacs 96 Separation Unit (Miltenyi), washed four times with RIPA buffer, and eluted by addition of 95° C. Lamelli Buffer (Bio Rad) with β-mercaptoethanol (Sigma). Samples were separated by SDS-PAGE, transferred to a PVDF membrane and probed with anti-CK1A antibody, anti-FK2 for polyubiquitinated proteins and anti-actin as a loading control

In Vitro Ubiquitination

293T cells were transfected with either HA-CK1A or FLAG-CRBN vectors. After 48 hours, cells were lysed in Pierce IP lysis buffer (Thermo Scientific) and immunoprecipitated overnight with FLAG-Sepharose beads (Anti-FLAG M2 Affinity Gel, Sigma) or HA-Sepharose beads (EZView Red anti-HA affinity gel, Sigma). The beads were washed 3× in IP lysis buffer and 2× in E3 Ligase Reaction buffer (Boston Biochem) and eluted with 250 μg/ml FLAG peptide (Sigma) or 100 μg/ml HA peptide for 30 min at 4° C. The eluates were mixed in a 1:1 ratio and added to a ubiquitination reaction mixture containing 200 nM E1 (UBE1), 2 μM UbcH5a, 1 μM UbcH5c, 1 μg/μL K₀ ubiquitin, 1 μM ubiquitin aldehyde, 1×Mg-ATP, 1×E3 Ligase Reaction Buffer (all Boston Biochem), 10 μM MG132, 100 nM MG101 and 1 μM lenalidomide, 10 μM lenalidomide, or DMSO (1:1000) as appropriate in a total volume of 25 μl.

Negative controls did not include E1 and P2 enzymes. After a 90 minute incubation at 30° C., the reaction was denatured by adding 5×SDS containing loading buffer (Boston Biochem), boiled at 95° C. for 5 minutes, separated by SDS-PAGE and transferred to a PVDF membrane in order to detect HA-CK1A and its ubiquitinated forms with CK1A antibody. The membrane was then stripped and re-probed with anti-FLAG antibody.

Purification, Culture, and Lentiviral Infection of Human CD34+ Cells for shRNA Experiments

Research cord blood units were obtained from The New York Blood Center according to an Institutional Review Board-approved protocol. Cord blood CD34⁺ hematopoietic cells were isolated from Ficoll purified PBMCs with an Indirect CD34 MicroBead kit (Miltenyi) and an Auto MACS Pro (Miltenyi) according to the manufacturer's protocol. Cells were cultured in serum free media (SFEM, stem span) containing 50 ng/ml recombinant human SCF (Miltenyi), 40 ng/μl human FLT3 ligand (Miltenyi), 25 ng/μl recombinant human thrombopoietin (Miltenyi), and 10 ng/μl IL-3 (Miltenyi). For shRNA experiments, CD34⁺ cells were transduced with a VSV-G pseudotyped TRC pLKO.005 lentiviral vector expressing GFP instead of puromycin resistance gene. Infection was performed after 24 hours in culture in a 96-well using spinfection in the presence of 2 μg/ml polybrene (hexadimethrine bromide, Sigma). 48 hours after transduction the number of transduced cells was analyzed by flow cytometry and was used as baseline. Then cells were cultured in 1 μM lenalidomide or DMSO and the relative number of infected cells was assessed by flow cytometry for 3 weeks.

Purification, Culture, and Lentiviral Infection of Patient Samples

Viably frozen bone marrow mononuclear cells were obtained from healthy donors or patient with del(5q) MDS according to IRB approved protocols at the University of Pennsylvania and Roswell Park Cancer Institute. Samples were thawed and CD34⁺ hematopoietic cells were isolated 20-24 hours later using an Indirect CD34 MicroBead kit (Miltenyi) and an Auto MACS Pro (Miltenyi). Cells were grown in serum free media (SFEM, StemSpan) supplemented with 25 ng/ml SCF, 40 ng/ml FLT3 ligand, 50 ng/ml thrombopoietin, 40 μg/mL lipids, 100 U/ml Pen/Strep and 2 mM glutamine. 6-8 hours after CD34⁺ isolation, cells were transduced with concentrated VSV-G pseuotyped EF1a-GFP-IRES-hCSNK1A1 cDNA virus or empty vector control via spinfection in the presence of 4 μg/ml polybrene (Sigma, diluted to 2 μg/ml after spinfection). After 3 days, the initial percentage of transduced cells was determined by flow cytometry and remaining cells were split to treatment with either DMSO or 1 μM lenalidomide. The relative abundance of transduced cells in each condition was assessed by after 5 days by flow cytometry. Control cord-blood CD34⁺ cells were isolated as above. Adult bone marrow CD34⁺ cells were purchased as single-donor lots from AllCells (Alameda, Calif.).

For qPCR validation of CSNK1A1 expression, cord blood CD34⁺ cells were transduced with lentivirus expressing GFP and hCSNK1A1 or empty vector. After 3 days, transduced GFP⁺ cells were FACS sorted and RNA extraction and qPCR was performed as above.

Expressing Different CRBN Proteins in Ba/F3 Cells

Variants of human and mouse CRBN were cloned into a modified pRSF91 backbone to generate SFFV-CRBN-IRES-GFP-T2A-Puro retroviral constructs. 200,000 Ba/F3 cells were infected with ecotropic retrovirus in the presence of 2 μg/ml polybrene. After 24 hours, 1 μg/ml puromycin (Gibco) was added and cells were selected for 3-4 days. Cells were confirmed to be >90% GFP+ by flow cytometry and 1,000,000 cells were plated per 6-well and treated with DMSO or lenalidomide for 24 hours. Protein lysates were harvested and immunoblotted for CK1α as described above.

IKZF3 Luciferase Reporter Assay

10,000 293T cells were transfected with 40 ng of CMV-IRES-RenillaLUC-IRES-IKZF3-FireflyLUC reporter plasmid. After 24 hours, cells were treated with DMSO and lenalidomide. 4 hours following treatment, luciferase activity was measured using the Dual-Glo Luciferase Assay System (Promega) according to the manufacturer's protocol.

Mouse Experiments

Mouse experiments were performed according to an IUCAC approved protocol at Children's Hospital Boston. Generation and characterization of the conditional Csnk1a1 knockout mouse has been described previously (Cancer Cell, 13; 26(4):509-20, 2014). Csnk1a1^(flox/flox) mice were crossed with Mx1Cre mice to obtain Csnk1a1^(flox/flox) Mx1Cre⁺ mice. Csnk1a1^(flox/flox) Mx1Cre⁺ or control Csnk1a1^(+/+) Mx1Cre⁺ mice were treated with 3 doses of 200 μg poly (I:C) (Invivogen HMW) at 8-10 weeks of age and gene excision was confirmed where applicable. At least 2 weeks following poly(I:C) treatment, the long bones and spines were harvested and crushed and RBC were lysed. CKit⁺ cells were isolated with a CD117 MicroBead Kit (Miltenyi) and an AutoMacs Pro and grown in SFEM (StemSpan) supplemented with antibiotics and 50 ng/ml mTPO (Peprotech) and 50 ng/ml mSCF (Peprotech) for 24 hours. Ecotropic pseudotyped retrovirus was spun onto Retronectin (Clontech) coated 6 well plates and cells were added in 1 ml of media with 2 μg/ml polybrene. An addition 1 mL media was added after 24 hours. After 48 hours, GFP+ or dTomato+ cells were isolated by FACS sorting (BD FACS Aria II) and CD45.1 and CD45.2 cells were mixed. Cells were treated with various doses of lenalidomide and the percent CD45.1 and CD45.2 cells expressing the fluorescent marker was followed by flow cytometry over time following cell surface staining. Antibodies for flow cytometry were as follows: CD45.1 APC/Cy7 (A20, BioLegend), CD45.2 PE (104, eBioscience), and CD45.2 FITC (104, eBioscience)

Other Embodiments

From the foregoing description, it will be apparent that variations and modifications may be made to the invention described herein to adopt it to various usages and conditions. Such embodiments are also within the scope of the following claims.

The recitation of a listing of elements in any definition of a variable herein includes definitions of that variable as any single element or combination (or subcombination) of listed elements. The recitation of an embodiment herein includes that embodiment as any single embodiment or in combination with any other embodiments or portions thereof.

All patents and publications, including U.S. Ser. No. 61/902,066, mentioned in this specification are herein incorporated by reference to the same extent as if each independent patent and publication was specifically and individually indicated to be incorporated by reference. 

1. A method of characterizing the lenalidomide- or lenalidomide analog sensitivity of a subject having a neoplasia characterized by increased IKZF1 or IKZF3 polypeptide expression, the method comprising (a) contacting a cell derived from the neoplasia with lenalidomide or a lenalidomide analog; and (b) detecting the level of an IKZF1 or IKZF3 polypeptide or polypeptide ubiquitination in the cell relative to the level in an untreated control cell, wherein detection of a decrease in IKZF1 or IKZF3 polypeptide level identifies the neoplasia as sensitive to lenalidomide or a lenalidomide analog and the absence of a decrease in IKZF1 or IKZF3 polypeptide level or polypeptide ubiquitination identifies the neoplasia as lenalidomide- or lenalidomide analog resistant.
 2. The method of claim 1, wherein the lenalidomide analog is thalidomide or pomalidomide.
 3. The method of claim 1, wherein the neoplasia is a B or T cell neoplasia.
 4. The method of claim 3, wherein the B or T cell neoplasia is mantle cell lymphoma, chronic lymphocytic leukemia, multiple myeloma, or B cell lymphoma.
 5. The method of claim 1, wherein the decrease in IKZF1 or IKZF3 polypeptide level is by at least about 20% or is undetectable by Western blot.
 6. The method of claim 1, wherein IKZF1 or IKZF3 polypeptide level is detected by immunoassay, radioimmunoassay, immunohistochemistry, FACS analysis, or quantitative fluorescent microscopy. 7-9. (canceled)
 10. The method of claim 1, the method further comprising detecting binding of CRBN to an IKZF1 or IKZF3 polypeptide in a biological sample of the subject relative to the level present in a reference, wherein detection of binding is indicative of lenalidomide- or lenalidomide analog sensitivity and a reduction in binding is indicative of lenalidomide- or lenalidomide analog resistance.
 11. The method of claim 1, the method further comprising detecting the sequence of an IKZF1 or IKZF3 polypeptide or polynucleotide in a biological sample obtained from the subject relative to a IKZF1 or IKZF3 reference sequence, wherein detection of a mutation in the IKZF1 or IKZF3 polypeptide or polynucleotide sequence is indicative of lenalidomide resistance and failure to detect a mutation is indicative of lenalidomide sensitivity. 12-19. (canceled)
 20. A method of reducing the proliferation of a cell characterized by increased IKZF1 or IKZF3 polypeptide expression, the method comprising contacting the cell with lenalidomide or a lenalidomide analog and an inhibitory nucleic acid molecule that reduces the expression or activity of an IKZF1 or IKZF3 polypeptide or casein kinase
 1. 21. The method of claim 20, wherein the inhibitory nucleic acid molecule is an antisense nucleic acid molecule, shRNA, siRNA molecule, or Crispr. 22-23. (canceled)
 24. The method of claim 20, wherein the inhibitory nucleic acid molecule is an antisense nucleic acid molecule, shRNA, siRNA molecule, or CRISPRi.
 25. (canceled)
 26. A recombinant murine cell, transgenic mouse, or knock-in mouse comprising a polynucleotide encoding a human CRBN polypeptide
 27. (canceled)
 28. The recombinant murine cell of claim 26, wherein the CRBN polypeptide comprises at least one substitution selected from the group consisting of S369C, V380E, and I391V. 29-33. (canceled)
 34. A method for assessing teratogenicity of lenalidomide or an analog thereof, the method comprising contacting the mouse of claim 26 with lenalidomide or an analog thereof, and assessing teratogenicity in pups produced by said mouse.
 35. (canceled)
 36. A method of assessing lenalidomide sensitivity in the murine cell, transgenic mouse, or knock-in mouse of claim 26, the method comprising contacting the murine cell, transgenic mouse, or knock-in mouse of claim 26 with lenalidomide or an analog thereof, and assessing lenalidomide sensitivity. 37-38. (canceled)
 39. A derivative of lenalidomide of formula 1:


40. A method of screening for agents that bind lenalidomide, the method comprising contacting the derivative of claim 39 with the agent and detecting binding to said derivative.
 41. A method of screening for agents that increase lenalidomide binding to CRBN, the method comprising contacting the derivative of claim 39 and CRBN with an agent, and detecting increased binding of CRBN to the derivative.
 42. The method of claim 40, wherein binding to CRBN is assayed by detecting the affinity of binding, by detecting ubiquination of IKZF1 or IKZF3, by detecting degradation of IKZF1 or IKZF3.
 43. A method of screening for agents that activate ubiquitin ligase, the method comprising contacting a ubiquitin ligase with the agent in the presence of IKZF1 or IKZF3, and detecting ubiquitin ligase activation. 44-48. (canceled)
 49. A method of identifying an agent that treats a myelodysplastic syndrome, the method comprising contacting the cell with the agent and detecting a decrease in casein kinase 1A1 polypeptide level in the cell relative to the level present in a reference, thereby identifying the agent as treating myelodysplastic syndrome.
 50. (canceled)
 51. A method of characterizing the lenalidomide or lenalidomide analog sensitivity of a subject having myelodysplastic syndrome, the method comprising (a) contacting a biological sample of the subject with lenalidomide or a lenalidomide analog; and (b) detecting altered casein kinase 1A1 polypeptide ubiquitination relative to the level present in a reference.
 52. (canceled) 